Oral Cavity Tumors Research Articles

SURGICAL MANAGEMENT OF ORAL CANCER WITH PRIMARY RECONSTRUCTION

Introduction: Primary tumours of oral cavity may be derived from the mucosa, salivary glands,bone or dental tissues. Over 90% of tumours of the oral cavity are squamous cell carcinomas.1,9 Reconstructive surgery following resection for oral cancer is considered when there is functional or aesthetic loss of structures in the oral cavity. Although primary closure can be achieved within oral cavity,the larger the defect,the more is the functional compromise.The majority of soft tissue repair within the oral cavity require three – dimensional reconstruction with soft pliable skin often without significant bulk. Aims : To study the proportion of oral cancer with surgical management with primary flap reconstruction.To analyse the different surgical modalities of treatment and its outcome.Materials And Methods: This study was carried out in a tertiary care hospital in Central India, from March 2020 to August 2021. Out of 136 patients diagnosed with oral cancer, 61 (44.85%) were found to be operable. 75 (55.15%) patients were inoperable, unfit or not willing for surgery.They were assessed,evaluated and managed accordingly. Results:Oral cancer was most commonly noted in fourth decade.The most involved site was alveobuccal complex.Flap reconstruction was required in 62.3% (38 out of 61) of the patients.Out of 38 patients,Pectoralis major musculocutaneous flap only was the most common flap reconstruction accounting for 19 out of 38 patients and in combination with Deltopectoral flap in 3 patients.Conclusion: Though free flap reconstruction has emerged as a good option in primary reconstruction with increased functional repair, strict post operative monitoring was needed as complications were more frequently encountered in those cases.

A Comparative Study of Conventional Tonsillectomy versus Coblation Tonsillectomy

BACKGROUND: Coblation tonsillectomy is a new surgical technique .This study compares coblation and traditional tonsillectomy techniques in view of their advantages and complication. AIM OF THE STUDY: To compare and study the advantages of conventional (Dissection and snare method) Tonsillectomy Versus Coblation Tonsillectomy with regards to Intraoperative Time, Intraoperative blood Loss, Post-Operative Pain and early return to normalcy. METHODOLOGY: Intraoperative Time, Intraoperative Blood Loss and Post-Operative Pain (visual analogue score), duration of hospital stay and complication. RESULTS: Peroperative time consumption and intra operative bleeding were very minimal with coblation method than with the conventional method. Post operative pain using symptomatic and visual analogue score were equal with the coblation and conventional method of tonsillectomy, but the average post operative pain by visual analogue score was lesser in coblation method, Coblation method was found to be SUPERIOR to conventional method using systemic criteria based prospective analysis. CONCLUSION: Compare to our Study Coablation will be useful in Adenoidectomy, Resection of tumors of larynx, hypo pharynx, oral cavity and oropharynx, Creating a cavity in a malignant lesion, Turbinectomy, Cost effectiveness, surgical skills, steep learning curve and microscopical settings were three main disadvantages with the coblation method. Coblation technique demands further research to be proven as a suitable and standard method.

The Impact of Post-Operative Radiotherapy in Early Stage (pT1-pT2N0M0) Oral Tongue Squamous Cell Carcinoma in Era of DOI.

Simple SummaryThe aim of the present study was to clarify the role of depth of infiltration (DOI) as an independent prognosticator in early stage (T1-T2N0M0) oral cavity tumors. Moreover, whether patients upstaged to pT3 for DOI > 10 mm need postoperative radiotherapy (PORT) in the absence of other risk factors has not been established yet. The DOI alone was not sufficient to impact the prognosis and therefore other risk factors should be considered to indicate PORT indications in upstaged patients due to DOI > 10 mm.Background: This study investigated the role of depth of infiltration (DOI) as an independent prognosticator in early stage (T1-T2N0M0) oral cavity tumors and to evaluate the need of postoperative radiotherapy in the case of patients upstaged to pT3 for DOI > 10 mm in the absence of other risk factors. Methods: We performed a retrospective analysis on patients treated with surgery and re-staged according to the 8th edition of malignant tumors classification (TNM). The role of DOI as well as other clinical/pathological features was investigated at both univariable and multivariable analyses on overall survival (OS), disease free survival (DFS), relapse free survival (RFS), and local RFS. Results: Among the 94 included patients, 23 would have been upstaged to pT3 based on DOI. Multivariable analysis showed that DOI was not an independent prognostic factor for any of the considered outcomes. The presence of perineural invasion was associated with a significant worse RFS (p = 0.02) and LRFS (p = 0.04). PORT was found to be significantly associated with DFS (p = 0.04) and RFS (p = 0.06). Conclusions: The increasing DOI alone was not sufficient to impact the prognosis, and therefore, should not be sufficient to dictate PORT indications in early-stage patients upstaged on the sole basis of DOI.

Retrospective Study of Feline Oral Cavity Neoplasms and Non-neoplastic Lesions, Between 2010 and 2020

Retrospective Study of Feline Oral Cavity Neoplasms and Non-neoplastic Lesions, Between 2010 and 2020

Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer.

PurposeIntensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT), two advanced modes of high-precision radiotherapy (RT), have become standard of care in the treatment of head and neck cancer. The development in RT techniques has markedly increased the complexity of target volume definition and accurate treatment delivery. The aim of this study was to indirectly investigate the quality of current TV delineation and RT delivery by analyzing the patterns of treatment failure for head and neck cancer patients in our high-volume RT center.MethodsBetween 2004 and 2014, 385 patients with pharyngeal, laryngeal, and oral cavity tumors were curatively treated with primary RT (IMRT/VMAT). We retrospectively investigated locoregional recurrences (LRR), distant metastases (DM), and overall survival (OS).ResultsMedian follow-up was 6.4 years (IQR 4.7–8.3 years) during which time 122 patients (31.7%) developed LRR (22.1%) and DM (17.7%). The estimated 2- and 5-year locoregional control was 78.2% (95% CI 73.3, 82.3) and 74.2% (95% CI 69.0, 78.8). One patient developed a local recurrence outside the high-dose volume and five patients developed a regional recurrence outside the high-dose volume. Four patients (1.0%) suffered a recurrence in the electively irradiated neck and two patients had a recurrence outside the electively irradiated neck. No marginal failures were observed. The estimated 2- and 5-year DM-free survival rates were 83.3% (95% CI 78.9, 86.9) and 80.0% (95% CI 75.2, 84.0). The estimated 2- and 5-year OS rates were 73.6% (95% CI 68.9, 77.8) and 52. 6% (95% CI 47.3, 57.6). Median OS was 5.5 years (95% CI 4.5, 6.7).ConclusionTarget volume definition and treatment delivery were performed accurately, as only few recurrences occurred outside the high-dose regions and no marginal failures were observed. Research on dose intensification and identification of high-risk subvolumes might decrease the risk of locoregional relapses. The results of this study may serve as reference data for comparison with future studies, such as dose escalation or proton therapy trials.

The role of brachytherapy in the curative treatment of oral cavity tumors

Összefoglaló. A szájüregi daganatok kuratív kezelésében az elsődlegesen választandó műtét mellett a sugárterápiának is jelentős szerepe van. A lokális tumormentesség biztosításához azonban dóziseszkaláció szükséges. Ennek külső besugárzással való megvalósítása a környező normálszövetek fölösleges dózisterhelésével és az ebből következő mellékhatások előfordulásának emelkedésével jár. A brachytherapia (BT) - amelynek során radioaktív sugárforrást/sugárforrásokat juttatunk a tumorba vagy annak közelébe - lehetővé teszi a helyileg magasabb dózis leadását a környező ép szövetek kímélésével. A BT a korai, T1-2N0 stádiumú szájüregi tumoroknál - kedvező prognosztikai faktorok mellett - akár kizárólagosan vagy mint posztoperatíve egyedül alkalmazott terápiás modalitás jön szóba. Kedvezőtlenebb prognózis esetén vagy előrehaladottabb stádiumban (T3-4 vagy N+) a műtétet és/vagy a percutan irradiációt kiegészítő eljárásként alkalmazható kedvező sugárfizikai tulajdonságai miatt. A kis dózisteljesítményű (low-dose-rate, LDR) BT-t már évtizedek óta alkalmazzák a terápiában, de ezt kezdi kiszorítani a nagy dózisteljesítményű (high-dose-rate, HDR), illetve a pulzáló dózisteljesítményű (pulse-dose-rate, PDR) BT. A jelen áttekintő tanulmány célja irodalmi adatok alapján a BT szerepének és indikációjának ismertetése a szájüregi daganatok kuratív kezelésében, alrégiókra lebontva. Orv Hetil. 2021; 162(37): 1471-1479. Summary. Radiation therapy plays a significant role in the curative treatment of oral cavity tumors, in addition to the primary choice of surgery. However, dose escalation is required to ensure local tumor control. Its implementation with external irradiation is accompanied by an unnecessary dose exposure to the surrounding normal tissues and an increase in the incidence of consequent side effects. Brachytherapy (BT), in which a radiation source/sources is/are placed inside or close to the tumor, allows a higher dose to be delivered locally, sparing the surrounding intact tissues. In addition to favorable prognostic factors in early T1-2N0 stage oral cavity tumors, BT is considered either exclusively or as a sole postoperative therapeutic modality. At less favorable prognosis or at a more advanced stage (T3-4 or N+), BT can be used as a complementary procedure after surgery and/or percutaneous irradiation based on its favorable radio-physical properties. Low-dose-rate (LDR) BT has been used in the therapy for decades, but recently it has been replaced by high-dose-rate (HDR) and pulse-dose-rate (PDR) BT. The purpose of this review is to describe the role and indications of BT in the treatment of oral cavity tumors categorized into subregions, based on the literature data. Orv Hetil. 2021; 162(37): 1471-1479.

A rare and unusual amyloid associated neoplasm of oral cavity: a potential pitfall

A rare and unusual amyloid associated neoplasm of oral cavity: a potential pitfall

The role of psycho-oncologic screenings in the detection and evaluation of depression in head and neck cancer aftercare patients

PurposeCancer and morbidity during a therapeutic regimen can result in somatic and psychiatric impairment. We have evaluated the need of appropriate psychological screening by analyzing a large collective of head and neck cancer (HNC) patients with particularly burdensome symptoms.MethodsHNC-aftercare patients were asked about somatic and psychological symptoms by means of standardized questionnaires of the European Organization for Research and Treatment of Cancer (EORTC Q30 and QLQ-H&N35). Patients with poor well-being values on the World Health Organization-5-Well-Being Index were screened for depression by using the Mini International Neuropsychiatric Interview, and adequate treatment was initiated, if necessary.ResultsOur sample consisted of 453 HNC-aftercare patients (average age 64.5 years; 72.0% male; 28.0% female). 25.1% showed abnormalities based on their WHO-5 questionnaire. A current major depressive episode was observed in 8.5% of the total study group. Patients with lip and oral cavity tumors showed the highest depression prevalence (18.9%). Time since initial HNC diagnosis showed no clear trend with regard to the number of depression cases. 50.0% of patients with a current major depressive episode consented to receiving assistance and/or therapy. Within the total study population, the most burdensome symptoms were found to be “dry mouth” (48.3%), “trouble doing strenuous activities” (46.0%), “trouble taking a long walk” (38.5%), and “worry” (35.5%). Aftercare patients with a depression diagnosis tended to have heavier symptom burdens than people without major depression.ConclusionsDespite the various cancer-related burdensome factors, prevalence levels of depression among the HNC-aftercare patients and the general population were similar. Nevertheless, since the number of diagnosed depression cases is high, the need for psychological treatment should be considered within the tumor collective. Furthermore, screening for depression should be implemented in clinical routines by using the appropriate standardized questionnaires.

Predictors of surgical site infection and pneumonia following oral cavity tumor surgery.

To identify risk factors for surgical site infection (SSI) and pneumonia following oral cavity tumor surgery. Retrospective chart review of a consecutive series of patients undergoing oral cavity resection. Several clinicopathologic variables were tested for their association with SSI and pneumonia. Three hundred and forty-four cases in 330 patients were included. Incidence of SSI and pneumonia was 67 (19.5%) and 38 (11%), respectively. On multivariate analysis, marginal mandibulectomy and segmental mandibulectomy were independent risk factors for SSI, whereas time under anesthesia (TUA) was an independent risk factor for pneumonia. Receiver operating characteristic curve identified 390 min as the cutoff above which pneumonia was predicted with a high degree of accuracy. In oral cavity resections, mandibulectomy predisposes to SSI. Further, prolonged TUA (>390 min) is a powerful predictor for pneumonia. As it is a modifiable risk factor, reduction in TUA might correspondingly lower the incidence of postoperative pneumonia.

Unipedal pectoralis major myocutaneous flap for reconstruction of skin defects in oral cancer surgery: A prospective study of 40 cases

Background: Reconstruction following oral cancer is very important part of the treatment defining both aesthetic and functional aspects. Options available for reconstructions are regional pedicle flaps and microvascular free flaps. Pectoralis major myocutaneous (PMMC) flap is regarded as the workhorse for reconstruction in the area of oral cavity and neck. A unipedicle PMMC is a good option for reconstruction of full thickness defects after resection of tumors of oral cavity. Material and Methods: A study was undertaken on patients of soft tissue defects of head and neck region after resection of tumor of oral cavity (squamous cell carcinoma). Total 40 patients, who were treated in the department of surgical oncology were included in this study. Results: Gingivo-buccal complex was the most common site observed for oral malignancy and majority of patients were in TNM stage- III in this study. Flap survival was good in majority of cases excluding one case of total flap necrosis and 5 cases of minor edge necrosis. Conclusions: Unipedal PMMC flap is effective in reconstruction of full thickness defect of oral cavity defects even in the era of free flap reconstructions especially in developing countries. Despite few minor flap related complications PMMC flap survival rate is high and total flap necrosis rate is uncommon.

Discrepancies between UICC and AJCC TNM classifications for oral cavity tumors in the 8th editions and following versions.

To underline discrepancies between the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) classifications in oral cavity cancer. Comparison between the UICC and AJCC TNM classifications of oral cavity cancer in their 8th editions and following versions. The most important update was the introduction of the depth of infiltration (DOI), which reflects the proximity of the tumor to the underlying lymphovascular tissues and was associated to the presence of nodal metastases. Since the first publication of the 8th edition of the AJCC Cancer Staging Manual on March 30, 2017, two further versions have been published, while the UICC TNM classification was left unchanged until a document containing modifications to the 8th edition of the UICC TNM Classification of Malignant Tumours was published online on October 6, 2020. Different versions of the TNM classification can be confounding for the scientific community. Citing the 8th edition of the UICC TNM Classification of Malignant Tumours or the AJCC Cancer Staging Manual without specifying the precise version used for classification may be insufficient. Clinicians and researchers are invited to always refer to the latest update of each classification.

Oral cavity tumors in children. Diagnostic approach

Although the majority of lesions reported in children and adolescents are benign, it should be recognized that oral malignant tumors do occur in children. The incidence of childhood malignancy is greatest in the 1st year of life, with the second peak to be found at 2–3 years of age. Many clinicians do believe that oral cancer is particularly aggressive in young patients, and is associated with poorer survival compared to adults. Numerous early reports of oral cancer in young adults concluded that the disease was more aggressive, and prognosis was poorer than in older adults. Purpose of this study is to make a literature review on the diagnostic methods of the tumors of oral cavity in children. Conclusion. Despite the progress in technology and medicine paraclinical examination methods in determining tumors of the oral cavity in children haven’t been developed and studied enough, thourder studies have to be done in order to create diagnostic protocols for the pediatric population.

Sequelae of congenital oropharyngeal teratoma in the oral cavity of the child

Congenital oropharyngeal teratoma is a rare tumor subtype with cells from the three germ layers, majorly being benign. Whereas teratoma develops early in intrauterine life, thus affecting the growth and development of adjacent structures, the purpose of this case report is to present the sequelae of this tumor in a child's oral cavity. Female child, 2 years and 3 months old referred by the otorhinolaryngologist for dental evaluation. The mother´s main complaint was the the child could not close her mouth. According to the child's medical record, at 34th week of gestation, during the routine ultrasound examination, the presence of the anechoic tumor mass was observed without Doppler signal, presenting a 3.2cm x 2.4cm diameter outside through the oral cavity. At 17 and 32 days of life, respectively, the excision of the largest and residual tumor located on the floor of the mouth was performed. Upon anatomopathological examination, the tumor with was classified as a mature teratoma. In the intraoral examination, a deep and atresia palate incomplete cleft palate, bone growth in the region of the posterior alveolar ridge of the maxilla, and in the posterior region of the mandible on the left side, "V" shaped mandible and microglossia, crowding were observed dental agenesis of the lower lateral incisors, absence of caries lesions, gingivitis and enamel development defects. The child will remain under the regular dental pediatric follow-up. Several sequelae were observed in the child's oral cavity and the need for multi-professional follow-up after excision of congenital oropharyngeal teratoma.

P-110 Variability in Minor Salivary Gland Tumors of Oral Cavity

P-110 Variability in Minor Salivary Gland Tumors of Oral Cavity

“A HISTOPATHOLOGICAL STUDY OF TUMORS OF ORAL CAVITY”

Background: The incidence of oral cavity neoplasms in the population has increased manifold over the years. Oral cancer is one of the common cancers in the world, common in India, and also in Bangladesh, Srilanka and Pakistan. Oral cancer is one of the few cancers, whose cause were known and hence it is possible to prevent. The real challenge in oral cancer lies in its prevention and early diagnosis. Objectives: 1.To study the morphological spectrum of neoplasms in oral cavity. 2.To study the age and gender incidence of various neoplasms. 3.To study the commonest sites of various neoplasms. 4.To evaluate or analyse the associated risk factors. Materials and methods: This is a prospective study of the cases attended to Government General Hospital, Vijayawada or Government Dental College Hospital Vijayawada, of oral cavity neoplasms. The biopsy of the tissues was carried out at the Department of Pathology, Siddhartha Medical College, Vijayawada. The study period was from June 2011 to August 2013 over a period of two years and three months. Results: The Study comprises a total of 74 surgical biopsies from oral cavity neoplasms received in the Department of Pathology, 52 of these were malignant lesions and 20 were benign tumour and 2 were premalignant conditions. The invasive squamous cell carcinoma was the most frequent histological type of oral cavity neoplasms. Among the oral cancers, peak age th th incidence was the 5 and 6 decade of life. There was signicant male preponderance. Tongue was the most common site involved. Smokeless tobacco consumption was the commonest associated habit which leads to malignancy. Conclusion:In thisa study we observed that among the oral cavity neoplasms, high incidence of carcinomas are seen, among these squamous cell carcinomas are predominant.

Social inequality in incidence and mortality of malignant neoplasms of lip, oral cavity and pharynx: Is Costa Rica an international paradox?

Low socioeconomic position (SEP) has been associated with higher incidences and mortality of lip, oral cavity and pharynx (LOP) cancers in the vast majority of countries with available data. The origins of health inequalities in cancer are socioeconomic, although they vary by time and country. Evidence from Low-and Middle-income Countries (LMICs) remains scarce. This study aims to identify and describe socioeconomic inequalities in LOP cancers incidence and mortality in Costa Rica. The hypothesis tested is that people leaving in low-SEP districts in Costa Rica have greater incidence and mortality rates of lip, oral cavity and pharynx cancers. The 10th revision of the InternationalClassification of Diseases (ICD-10) was used to define cancer sites. Data come from a national population-based Cancer Registry with 100% completeness to study incidence. Incidence rate included all new cases of LOP cancer diagnosed from January 1, 2011, and December 31, 2015, for a total of 2798517 individuals, 13832524years of follow-up and 601 LOP cases. Mortality rate was extracted from the National Death Index, including 2739733 individuals, 23950240 person-years of follow-up and 586 LOP cancer deaths, from January 1, 2010, to December 31, 2018. The 2011 Census (with 94% of Costa Rican inhabitants) was used to characterize the urbanicity and wealth of 477 districts. Survival models were performed for both incidence and mortality, allowing to consider existing competitive risks. Cox models were used for incidence, and parametric survival models based on a Gompertz distribution for mortality. The study found that people who lived in the most socioeconomically disadvantaged areas had lower probabilities of developing LOP cancers than people in the richest districts. The same pattern for mortality, however, was not significant. The hypothesis that incidence and mortality of LOP cancers will show a positive social gradient was not confirmed in this study, contradicting the existing literature. This could be explained by the social distribution of risky health behaviours, more frequent in socially advantaged populations.

The T-N tract involvement as a new prognostic factor for PORT in locally advanced oral cavity tumors.

The space comprised between tumor and neck lymph nodes (T-N tract) is one of the main routes of tumor spread in oral cavity tumors. Aim of the study was to investigate the impact of T-N tract involvement on the postoperative radiotherapy (PORT) outcomes. Patients (pts) treated between 2000 and 2016 with indication to PORT were retrospectively retrieved. Inclusion criteria were: (a) locally advanced tumors of the oral cavity, (b) who received with indication to PORT (c) with a minimum follow-up of six months. One hundred and fifty-seven pts met the inclusion criteria (136 pts treated with PORT and 21 pts not treated with PORT). In the PORT cohort, the T-N tract involvement had no impact on both OS (p=.09) and LRFS (p=.2). Among the non-PORT cohort, both OS (p=.007) and LRFS (p=.017) were worse for pts with positive T-N tract compared to those with negative T-N tract. PORT improved both OS (p=.008) and LRFS (p=.003) in pts with positive T-N tract but not in those with negative T-N tract (p=.36 and p=.37, respectively). Our results suggest that involvement of T-N tract should be considered as prognostic factors informing the indication to PORT.

Oral cavity and a second primary cancer in the larynx

Head and neck cancer represents the sixth most common cancer in the world. Men are affected two to three times more than women, possibly as a result of higher tobacco and alcohol consumption. Oral cavity tumors have the highest rate of developing second primary malignancies. In patients with malignancies associated with alcohol and tobacco consumption, 80% of second primary tumors appear in the oral cavity, oropharynx, and larynx. Second primary tumors are usually invasive in nature with early metastasis and should be treated with aggressive therapy. Herein, we report a rare case of a second primary cancer in the larynx after a gingival squamous cell carcinoma.

Update on MRI for Oral Cavity.

Magnetic resonance imaging (MRI) is the imaging modality of choice to evaluate the complex anatomy and pathology of the oral cavity. In this article, an overview of MRI findings of common benign lesions in the oral cavity including congenital, vascular, and inflammatory/infectious lesions will be reviewed. In addition, MRI findings of common benign and malignant oral cavity tumors will be presented.

IMPROVED DIAGNOSISFOR ORAL MUCOSAL TUMORSIN THE DENTIST’S OFFICE

Based on currently available literature, clinical examination remains the major method when handling cases of suspected malignancy. However, this method does not allow diagnosing cancer, due to which a large group of patients with possible oral mucosa cancer are referred to an oncologist. The search and use of affordable non-invasive methods for early diagnosis of oral mucosa tumors is an urgent issue facing the health system. The study involved analyzing 134 records of outpatients examined at the Samara Regional Oncological Clinic who were referred by dentists within 2014-2019 from the local polyclinic in Samara due to detection of tumors in oral mucosa and who underwent a biopsy. The patients were divided into two groups according to the examination methods. The inclusion criteria were: detection of various superficial oral mucosa neoplasms; referral from the dentist. The exclusion criteria were as follows: patients with submucosal oral cavity neoplasms referred to the oncologist by other medical specialists or self-referred patients. The control group included 63 patients who, after a conventional examination (including interview, examination, palpation), underwent an incisional biopsy followed by morphological examination at the oncologist’s office. In the major group, in 71 patients at their respective initial dental appointments a special examination algorithm was applied. This algorithm entailed an assessment of the identified risk factors. Indications for biopsy were identified using the histological verification index (HVI). Apart from the conventional examination methods (interview, examination, palpation), autofluorescence stomatoscopy was used, this being done for the purpose of differential diagnostics of inflammation, precancerous and malignant issues, depending on the glow type. In the main group, the initial stages of oral mucosa cancer were detected in 17 patients after biopsy; in the control group – in 4 patients (p=0.004). The developed algorithm used for scoring the patient’s clinical examination data combined with autofluorescence stomatoscopy allowed diagnosing accurately (90% of reliability) precancerous and cancerous diseases, as well as to use invasive research methods (biopsy) strictly following the indications. Aim of study: to improve diagnosis of oral mucosa neoplasms through improvement of the examination algorithm.