Intraoral Cancer Research Articles

Ill-Fitting Dental Appliances and Oral Cancer: A Systematic Review and Case Report

Background: Associations between the use of dental appliances and oral cancer remain controversial. No studies have reported a relationship between dental appliances in the setting of cleft palate management and oral cancer. This study characterizes the correlation between dental appliances and oral cancer and includes a case report of a patient with a history of cleft palate repair who later developed oral squamous cell carcinoma (OSCC). Methods: We performed a systematic review for studies from 1980 to 2022 of patients who had dental prostheses and who were subsequently diagnosed with OSCC. Variables included the percentage of OSCC cases wearing dental appliances, intraoral cancer location, and noted associations between reported risk factors and OSCC. Results: Of the 6323 patients from the 31 articles analyzed, the most common specified locations for the neoplastic lesion were at the gingiva and lateral border of the tongue. Seventeen studies found an association between OSCC and denture use (54.8%), while 9 studies (29.0%) specifically found a positive association between oral sores and OSCC. Our case patient had complete dental extraction at the age of 12 with subsequent life-long dentures. At age 69, he presented with invasive OSCC. Conclusions: Chronic irritation from ill-fitted dental appliances are associated with oral sores and cancer. This study reports a cleft palate repair patient with lifelong use of dentures who presented with OSCC despite having no known risk factors for oral cancer.

A study of incidence and propensity of locoregional lymph nodes in clinically N0 cases of carcinoma of tongue

Background: Oral cavity cancer is the sixth most common cancer worldwide with a high prevalence in South Asia. Among the populations where tobacco chewing is not endemic, tongue is the most frequent subsite for intraoral cancer. Methods: The prospective observational study was done at our tertiary care centre on 50 patients. CECT neck was done in all the clinically N0 (zero) cases to know the extent of tumour and neck metastasis. Wide local excision with elective neck dissection (END) was done for all clinically N0 cases with 1 year follow-up. Results: Clinical examination had high false negatives, sensitivity of CT scan imaging=18/20×100=90%, positive predictive value of CT scan imaging=18/26×100=69.23% and diagnostic accuracy=40 (18+22)/50=80%. Significant association was found between neck lymph node metastasis and tumor thickness. No significant association was found between grade of tumor and metastasis. Conclusions: CECT neck help to delineate the extent of END in carcinoma of tongue. In early-stage squamous cell carcinomas of the tongue (T1 and T2), a tumour thickness >5 mm should be taken as an indicator for prophylactic neck dissection as it is significantly associated with subclinical metastasis. Hemiglossectomy should be preferred over partial glossectomy to achieve better locoregional clearance and in turn to reduce rate of local recurrence. Hemiglossectomy with prophylactic END followed by appropriate chemoradiotherapy reduces locoregional recurrences and improved overall survival rate in early stage I and II of oral tongue squamous cell carcinoma (OTSCC).

INTRA-ORAL AND LOWER LIP SQUAMOUS CELL CARCINOMA: A COMPARATIVE ANALYSIS OF THE LYMPHOCYTIC HOST RESPONSE

Objectives To compare the effect of lymphocytic host response (LHR) in the prognosis of patients with tongue and/or floor of mouth squamous cell carcinoma (TFMSCC) and with lower lip squamous cell carcinoma (LLSCC). Study Design Records and slides from 179 patients were evaluated according to the histopathologic risk assessment (HRA) to LHR and submitted to bivariate (chi-square) and survival (Kaplan-Meier and log-rank) analyses. Results White male smokers at initial cTNM were the most affected, in both the TFMSCC and LLSCC. Tumors with strong LHR (61.9%) predominated and were classified as intermediate risk (56.9%) by AHR for TFMSCC and LLSCC. Associations between dense continuous band of LHR and smoking (P = .019), tumors located in the tongue or lower lip (P ≤ .0001), initial pTNM (P ≤ .0001), no recurrence (P = .021), moderately differentiated tumors (P = .001), and intermediate risk by AHR (P ≤ .0001) were observed. Patients with weak LHR had poor overall survival (OS) (P ≤ .0001) and disease-free survival (DFS) (P = .002). Conclusions For both lower lip cancer and intraoral cancer, the presence of a strong LHR demonstrates a favorable effect for OS and DFS and proved to be an important prognostic factor for these patients. To compare the effect of lymphocytic host response (LHR) in the prognosis of patients with tongue and/or floor of mouth squamous cell carcinoma (TFMSCC) and with lower lip squamous cell carcinoma (LLSCC). Records and slides from 179 patients were evaluated according to the histopathologic risk assessment (HRA) to LHR and submitted to bivariate (chi-square) and survival (Kaplan-Meier and log-rank) analyses. White male smokers at initial cTNM were the most affected, in both the TFMSCC and LLSCC. Tumors with strong LHR (61.9%) predominated and were classified as intermediate risk (56.9%) by AHR for TFMSCC and LLSCC. Associations between dense continuous band of LHR and smoking (P = .019), tumors located in the tongue or lower lip (P ≤ .0001), initial pTNM (P ≤ .0001), no recurrence (P = .021), moderately differentiated tumors (P = .001), and intermediate risk by AHR (P ≤ .0001) were observed. Patients with weak LHR had poor overall survival (OS) (P ≤ .0001) and disease-free survival (DFS) (P = .002). For both lower lip cancer and intraoral cancer, the presence of a strong LHR demonstrates a favorable effect for OS and DFS and proved to be an important prognostic factor for these patients.

INTRAORAL AND LIP CANCER MORTALITY IN BRAZILIAN WOMEN: TIME TRENDS FROM 1980 TO 2018

<h3>Objectives</h3> To investigate the female mortality rate of intraoral and lip cancer in Brazil between 1980 and 2018 by anatomic location and Brazilian geographic regions. <h3>Study Design</h3> This was a descriptive ecological time series study. With secondary data based on official population estimates, the age-adjusted annual mortality rates were obtained by sex, anatomic location, and Brazilian geographic regions, and the annual percentage change was calculated. Data sets were analyzed using the Joinpoint Regression program. <h3>Results</h3> Of the 81,918 individuals who died from oral cancer during 1980 to 2018, 18,385 were women. The age-adjusted mortality rate for women was 0.47/100,000 in 1980 and 0.57/100,000 in 2018. A decrease in lip cancer mortality during 1980 to 2018 and intraoral cancer mortality in the 1980s was observed; however, in the last 2 decades, there were significant increases in female mortality, mainly due to cancer at the base of the tongue. Importantly, the northeast region presented a significant increase between 1993 and 2007 and the south and southeast regions have shown significant reductions since the 1990s. <h3>Conclusions</h3> There was a significant increase in the mortality rate due to oral cancer in Brazilian women during these 38 years.

The Role of Dental Professionals in the Early Detection of Oral Cancer

Oral health care providers are uniquely positioned to expertly perform extra- and intraoral cancer screening exams, which can save patient lives. This article discusses the importance of performing oral cancer screenings as part of every comprehensive and periodic oral exam as well as factors that may prevent routine screening and biopsy of suspicious lesions. It also discusses how to approach patients with oral leukoplakia, erythroplakia and chronic, nonhealing ulcers.

Ağız İçi Kanserlerin Eksizyonu Sonrasında Gelişen Defektlerin Serbest Fleplerle Rekonstrüksiyonu

Ağız İçi Kanserlerin Eksizyonu Sonrasında Gelişen Defektlerin Serbest Fleplerle Rekonstrüksiyonu

Strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic.

During the current pandemic scenario, maxillofacial rehabilitation specialists involved with supportive care in cancer must transform its practice to cope with COVID-19 and improve protocols that could quickly return the oral function of complex cancer patients who cannot wait for surgical complex rehabilitation. This includes the role of the maxillofacial prosthodontist for the rehabilitation of surgically treated patients with maxillary cancers by the means of filling obturator prostheses that are considered an optimal scientific-based strategy to reduce hospital stay with excellent pain control, oral function (speech, swallowing, mastication, and facial esthetics), psychologic and quality of life outcomes for the patients following intraoral cancer resection. Therefore, the aim of this commentary was to bring new lights to the strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic as well as to present a protocol for managing such cases.

Are contralateral submental artery perforator flaps feasible for the reconstruction of postoperative defects of oral cancer?

We evaluated the clinical applications of the reconstruction of postoperative defects of the oral cavity using contralateral submental artery flaps. A retrospective study of 18 patients with postoperative intraoral cancer defects reconstructed with contralateral submental artery perforator flaps between October 2018 and October 2019 in our department was conducted. The defect area, flap size, and complications were evaluated. All patients were diagnosed based on pathological examinations: 2 with adenoid cystic carcinoma and 16 with squamous cell carcinoma. The submental artery perforator flap used for simultaneous repair was 8 to 15 cm in length and 4 to 6.5 cm in width. The survival rate of flap reconstruction was 100% with no donor site complications. Contralateral submental artery flap reconstruction is a suitable alternative for moderate to large intraoral defects, postoperative mouth floor defects, and oral cavity composite defects of oral malignant tumors without contralateral lymph node metastases.

Effect of Black Raspberry on NF-κB and Caspase-3 Expression in Head and Neck Squamous Cell Carcinoma versus keratinocytes and fibroblasts cell lines

Review: Oral squamous cell carcinoma (OSCC), the most common type of intraoral cancers, is an important health issue. Most cytotoxic drugs have side effects on normal tissues beside being cytotoxic to malignant cells. Many studies demonstrated the ability of black raspberries (BRBs) to inhibit many types of cancer. However, understanding how the bioactive compounds in BRBs drive the metabolic and molecular pathways that lead to oral cancer chemoprevention remains unclear.Aim of study: The current study aimed to investigate the consequences of BRBs treatment on (NF-κB) and caspase-3 expression in two types of head and neck SCC cell lines in comparison to both normal keratinocyte and fibroblast cell lines. Results: There was an inhibitory effect of BRBs on both tested malignant cell lines (SCC9), and (HEp-2) and at the same time there was no effect on growth of the tested normal cell lines (HaCaT) and (BJ). There was a statistically significant increase in median fold change of caspase-3 in the tested malignant cell lines and a statistically significant decrease in the median fold change of NF-κB in the tested malignant cells with no detectable change for both antigens in the normal cell lines.Conclusion: The results of the present study provide more evidence that BRBs have a very promising cytotoxic effect on oral cancer cell lines with no detectable harmful effect on normal cells.

Outcomes for patients with second primary malignancy after primary surgical treatment for early-stage squamous cell carcinoma of the oral cavity.

The purpose of our article was to describe a tertiary center's experience with patients with primarily surgically treated early-stage intraoral cancer with a second primary malignancy confirmed during follow-up. A total of 183 patients were primarily surgically treated for oral cancer between 2000 and 2004. Among these, 24 patients (13.1% (24/183)) met inclusion criteria. There were 22 men (91.7%) and 2 women (8.3%) with a median age of 59.5 years. Patients with head and neck cancer with a second primary malignancy had significantly higher survival compared to nonhead and neck cancer with a second primary malignancy. Patients with head and neck cancer with second primary malignancy were diagnosed during the period of 14 to 45 months (median 29 months), whereas nonhead and neck cancer with second primary malignancy occurred in a period of 7 to 46 months (median 19 months). This study highlights the importance of optimizing screening strategies for second primary malignancies. In order to improve the survival of patients with head and neck squamous cell carcinoma (HNSCC), effective programs of screening and/or chemoprevention of second primary malignancies are essential.

Functional rehabilitation in advanced intraoral cancer: erratum.

Functional rehabilitation in advanced intraoral cancer: erratum.

Intraoral stents in preventing adverse radiotherapeutic effects in lip cancer patients.

To fabricate and evaluate the efficacy of individualized intraoral stents to minimize the potential side effects of radiation on oral tissues in patients with early stages of lip cancer. Lower lip cancer is a common tumor found almost exclusively in middle-aged and elderly males. Surgery is the most common treatment of choice, although for less extensive lesions, exclusive radiotherapy may be preferred. Some studies have found that the use of intraoral stents in patients with intraoral cancer (e.g., of the tongue or floor of the mouth) obtained favorable results in preventing unnecessary radiation doses to adjacent normal tissue and reducing oral complications. However, studies investigating the efficacy of individualized intraoral stents in patients with lip cancer have not been reported in the literature. Six patients with early stage lip cancer were eligible for curative radiotherapy and personalized intraoral stents. The stents were fabricated and all participants were evaluated for the occurrence of oral complications. The regions of the oral mucosa protected from radiation by intraoral stents showed no mucositis. One patient complained of mild oral dryness but without interference in habits. At follow-up, none of the patients had late xerostomia or signs of dental caries by radiation. The use of individualized intraoral stents was shown to be promising in reducing the adverse effects of radiation therapy in lip cancer patients. These findings highlight the importance of a multidisciplinary team during oncological therapy.

Functional rehabilitation in advanced intraoral cancer.

Introduction:Modern treatment of advanced intraoral cancer involves multidisciplinary teams with use of complicated reconstructive techniques to provide improved survival with optimal rehabilitation. Mastication is an important part of this process, and it can be severely impaired by tumor ablation. Whether flap reconstruction is a determinant factor in dental rehabilitation is still in debate.Patients and methods:Thirty-five patients with advanced intraoral cancer were reviewed to determine dental rehabilitation of different reconstructive techniques. The patients were treated with a multidisciplinary team approach. The patients’ demographics, primary treatment, reconstructive surgery, dental rehabilitation, and functional outcome were recorded and analyzed.Results:Nine patients had Stadium III disease, and 26 patients had stadium IV. Thirty-two patients (91.42%) received postoperative radiotherapy. Masticatory and dental functional rehabilitation of patients was very poor. Only 15 patients (42.86%) could eat a normal diet, whereas 18 patients (51.42%) could manage only soft diets, and 2 patients (5.72%) could only be fed with a liquid diet. Denture rehabilitation was even more frustrating and had a direct impact on masticatory rehabilitation. Only 10 patients (28.57%) could use dentures postoperatively and 40% of patients (14 patients) could not use any denture at all. Above all reconstructive techniques, the free radial forearm flap provides the best functional outcome.Conclusions:Reconstruction of advanced intraoral cancer results in poor denture rehabilitation, especially when bulky flaps are used. If massive resections are necessary, the free radial forearm flap reconstruction provides the best functional outcome.

The burden of oral cancer in sub-Saharan Africa

Objectives: To describe incidence and mortality rates of oral and of oropharyngeal cancers in sub-Saharan Africa using available sources and to discuss shortcomings. Methods: Incidence and mortality rates were obtained from GLOBOCAN online (IARC 2012) and the pathology-based South African National Cancer Registry (SA-NCR). Descriptions of oral and of oropharynx cancers for the four main geographical regions were derived from the literature. For South Africa, the incidence by ethnic group of lip and intra-oral cancer over the period 1988–2012 could be calculated from SA-NCR. The age distributions for intraoral and for oropharynx cancer in both genders in South Africa were compared for the period 1996–2002. Results: Age standardized incidence rates and mortality rates of lip and of oral cancer in sub-Saharan Africa varied substantially, depending on the regions, the mix of carcinogenic substances consumed in each country and the quality of the cancer registry data. African islands in the Indian Ocean and the Southern and Eastern African countries report the highest rates; these are generally reported to be much lower in West African countries. Available data are now old: not beyond 2010. Up until that time, in the Republic of South Africa, there appears to have been a slight decline in oral cancer rates, except in Black females, but a rise this millennium in cancer of the oropharynx, especially in Coloureds (mixed-race). At least until 2002, the Human Immunodeficiency Virus infection (HIV) pandemic had little or no stimulating influence on the incidence rates of oral squamous carcinoma in South Africa, although Kaposi’s sarcoma has been a major burden in the past. Asian and mixed-race South African females had the highest levels of oral squamous cell carcinomas in the &lt;45 year age group. Conclusion: The quality of cancer registry data in sub-Saharan Africa is variable, unreliable and out of date, suggesting gross under-ascertainment. Records of all causes of death are poor, which can result in both under- and over-attribution of cancer mortality. Improvements of the necessary resources for cancer registration and death certification deserve a high priority.

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer

ABSTRACTObjective This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites.Material and Methods A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type.Results From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015).Conclusions Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors.

Involvement of Microglial P2Y12 Signaling in Tongue Cancer Pain

To elucidate if microglial P2Y12 receptor (P2Y12R) mechanisms are involved in the trigeminal spinal subnucleus caudalis (Vc; also known as the medullary dorsal horn) in intraoral cancer pain, we developed a rat model of tongue cancer pain. Squamous cell carcinoma (SCC) cells were inoculated into the tongue of rats; sham control rats received the vehicle instead. Nociceptive behavior was measured as the head-withdrawal reflex threshold (HWRT) to mechanical or heat stimulation applied to the tongue under light anesthesia. On day 14 after the SCC inoculation, activated microglia and P2Y12R expression were examined immunohistochemically in the Vc. The HWRT was also studied in SCC-inoculated rats with successive intra–cisterna magna (i.c.m.) administration of specific P2Y12R antagonist (MRS2395) or intraperitoneal administration of minocycline, a microglial activation inhibitor. Tongue cancer was histologically verified in SCC-inoculated rats, within which the HWRT to mechanical stimulation of the tongue was significantly decreased, as compared with that of vehicle-inoculated rats, although the HWRT to heat stimulation was not. Microglia was strongly activated on day 14, and the administration of MRS2395 or minocycline reversed associated nocifensive behavior and microglial activation in SCC-inoculated rats for 14 d. The activity of Vc wide dynamic range nociceptive neurons was also recorded electrophysiologically in SCC-inoculated and sham rats. Background activity and noxious mechanically evoked responses of wide dynamic range neurons were significantly increased in SCC-inoculated rats versus sham rats, and background activity and mechanically evoked responses were significantly suppressed following i.c.m. administration of MRS2395 in SCC-inoculated rats as compared with sham. The present findings suggest that SCC inoculation that produces tongue cancer results in strong activation of microglia via P2Y12 signaling in the Vc, in association with increased excitability of Vc nociceptive neurons, reflecting central sensitization and resulting in tongue mechanical allodynia.

Abstract 3875: Proteome-wide approach to identify novel biomarkers in oral tumorigenesis

Abstract Oral cancer is the most common type of intraoral head and neck cancer in humans, with a worldwide prevalence of more than 400,000 cases. In India, oral cancer ranks in top three in comparison with other cancer types. The majority of oral cancer patients are diagnosed at an advanced disease stage. Although, there have been many advances in oral cancer treatment, the overall survival rate of oral cancer patients only improved marginally over the past 30 years. The treatment regimen of oral cancer is mainly based on the tumor, node and metastasis (TNM) classification and histopathological diagnosis. These methods are subjective and often have low sensitivity to detect the disease in early stages. Hence, there is an urgent need for early diagnosis to develop biomarkers; to identify high risk individuals, to improve cancer detection at early stages, to predict disease outcome and response to therapy. Proteomics have been successfully employed in studies of lung, breast, prostate, gastrointestinal cancer, and head and neck squamous cell carcinoma. Reports are not much available to describe well characterized biomarkers which will aid for early detection of oral cancer. Racial differences were reported in many cancers including its morbidity, mortality, treatment response and survival rates. In Indian patient population, there is a significant knowledge gap exists in utilizing proteomics for biomarker discovery. The aim of this study is to identify novel candidate genes which may be used as prognostic or diagnostic biomarkers for Indian oral squamous cell carcinoma. The tongue tumor and adjacent normal samples were subjected to 2D - Differential in Gel Electrophoresis (2D-DIGE). Differentially expressed proteins in tumor samples were identified using nano-LC-MS/MS and validated by quantitative real time PCR. We found 800 protein spots were differentially expressed and seventy proteins were identified by mass spectrometry. Among them twelve proteins including Myosin isoforms, hemoglobin beta, Annexin A1, Creatinine kinase, Carbonic anhydrase, HSPA8 showed decreased expression while eighteen proteins including Apolipoprotein A1, HSPA5, Alpha 1 antitrypsin, Annexin isoforms, Peptidyl prolyl cis trans isomerase, Serpin isoforms, Tropomyosin, Thioredoxin, Alpha enolase, Calpain, Glutathione S Transferase, Heat shock protein beta 1, S100 isoforms showed increased expression in tongue tumor tissues. Most of the differentially regulated proteins were known to be involved in calcium homeostasis, cell cycle, cell growth and migration. The major outcome of this study was the identification of novel protein molecules which might be used as predictive, prognostic and diagnostic biomarkers for oral cancer. These proteins can also serve as a therapeutic intervention targets for oral cancer progression. This study would be the first study to map the whole proteome profile of the cancerous as well as normal tongue cheek tissue in Indian scenario. Citation Format: Sivagnanam Ananthi, Naga Padma Lakshmi CH, Anbarasu K, Mahalingam Sundarasamy. Proteome-wide approach to identify novel biomarkers in oral tumorigenesis. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3875.

Prediction of high naevus count in a healthy UK population to estimate melanoma risk

Not only do dentists have a pivotal role in screening for intra-oral cancer, but also for facial skin perturbations.

Submental Artery Flap with Sentinel Lymph Node Biopsy in the Reconstruction of Oral Cancer

Microvascular free flaps form the gold standard for reconstruction of defects after intraoral cancer surgery, but not all patients are suitable candidates for microsurgery. The submental artery flap is an alternative to free tissue transfer especially in patients who do not tolerate extensive operations due to major comorbidities. However, in metastatic neck disease, this option has not been recommended due to theoretical intraoral transfer of cancer cells. The aim of this study was to consider the indications and benefits of the submental artery perforator flap in patients with intraoral cancer. Ten patients with early (N = 2) or locally advanced (N = 8) intraoral cancer, who were not candidates for free tissue transfer because of major comorbidities, were managed with tumor resection and coverage of the defect with the submental artery flap. The minimum follow-up time for all patients was 6 years. The average defect size was 5 × 9 cm. Two patients developed major complications and one of them had a flap loss. Sentinel lymph node biopsy was used in three cases to rule out positive neck disease close to the flap pedicle. During the follow-up time 6 out of 10 patients had a local recurrence and there were no appearances of metastatic neck disease. The submental artery flap is an alternative option to intraoral microvascular reconstruction in patients with major comorbidities. Sentinel lymph node biopsy can be used as an adjunct to enhance oncological safety.

The submental island flap for the treatment of intraoral tumor-related defects: No effect on recurrence rates

The submental island flap has become increasingly popular in the treatment of intraoral defects following tumor ablation. However, there was concern that the elevation of the pedicled flap might interfere with the efficiency of level I-lymph node dissection and decrease the oncologic prognosis of the patients. In a prospective clinical study over five years the outcome of 45 consecutive patients with intraoral cancer of various T-stages treated with submental island flaps was evaluated and compared to 45 patients with a T-status analogous oral cancer treated with free radial forearm flaps. All submental island flaps beside three were successful (93.3%). The obtained functional results were pleasing and the donor morbidity low. Patients treated with submental island flaps exhibited no enhanced risk of local tumor recurrence or lymph node metastasis (p<0.86). In contrast, the operation time, time of intensive care and hospitalization were reduced (p<0.001). We conclude that the submental island flap is an effective and predictable option of small and medium-sized oral defect treatment. It is a valuable alternative to free flap soft tissue reconstructions such as radial forearm or perforator flaps. It seems particularly beneficial to patients with relevant comorbidities as often present in the oral cancer population. The application of the submental island flap does not reduce the oncological prognosis of oral cancer patients.