Oral Tongue Carcinoma Research Articles

Modular anatomic approach to oral tongue carcinoma: functional outcomes and quality of life.

The purpose of this study is to present the long-term functional swallowing outcomes of various surgical approaches to oral tongue/floor of mouth squamous cell carcinoma (OTFOMSCC) according to a modular and compartment-based concept previously described elsewhere. A retrospective study was conducted on patients undergoing surgery for OTFOMSCC from January 2017 to April 2023 in the Department of Otorhinolaryngology at the Hospital of Bolzano. Functional swallowing outcomes and quality of life (QoL) were assessed through the administration of a scale and questionnaires between 6 months and 1 year postoperatively or after the end of adjuvant therapy, stratifying the results according to the surgical technique used. A total of 92 patients with OTFOMSCC were enrolled: 44 patients underwent transoral anatomically guided surgery (TAGS) for early-stage tumours, and 48 underwent major surgery for advanced stages. Among the latter 48 patients: 35 underwent compartment tongue surgery (CTS), 3 underwent extended glossectomies (EG) Type A, 6 underwent EG Type B, and 4 underwent EG Type C. After TAGS, all patients resumed oral feeding for all consistencies. In the CTS group, only one patient faced challenges with pure liquids, yet all achieved the target of consuming a semisolid and semiliquid diet. EG exhibited a noticeable decline in performance from Type A to total glossectomy (Type C). Following an anatomically-guided approach to the resection of OTFOMSCC allows the surgery to be modulated on the structures involved by the tumour, thus achieving optimal oncological results, while maintaining the possibility to predict functional outcomes and postoperative QoL.

Contralateral submental artery island flap for oral tongue reconstruction — a retrospective study in patients with oral tongue squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is a leading cause of cancer-related death in developing countries. The oral tongue is the most common site involved by OSCC. About a third of the patients have neck nodal metastasis at presentation. Reconstruction of the oral tongue after resection for cancer is necessary for proper rehabilitation. For patients who are medically unfit for prolonged surgery like a free tissue transfer, local flaps are employed for tongue reconstruction. The submental flap is a popular option. However, when there is extensive floor of mouth involvement or bulky nodal disease in ipsilateral level 1, harvesting the submental flap based on contralateral facial vessels is possible, without compromising oncological safety. We discuss the feasibility and outcomes of contralateral submental artery island flap for reconstruction after resection of oral tongue carcinoma in a retrospective series of 34 patients followed up for a median of 8.5 months. ResultsOf the 34 oral tongue cancer patients in the study, 16 had neoadjuvant chemotherapy prior to surgery. 33 underwent bilateral neck dissection. Two patients had partial flap loss which was managed conservatively. There were five patients who had either locoregional or distant recurrence, none in the flap site. Three had pathological positive nodes at contralateral level 1b and two had pathologically positive nodes in contralateral level 1b. Tongue motility and speech intelligibility were satisfactory on follow-up. ConclusionIn the properly selected patient, the contralateral submental artery island flap offers an oncologically safe and technically simpler alternative for free flap reconstruction.

Postoperative radiotherapy for pT1-2N0 oral tongue carcinoma: time to reconsider?

Postoperative radiotherapy for pT1-2N0 oral tongue carcinoma: time to reconsider?

Deep margin assessment by intraoperative ultrasound in tongue cancer- dust trial

Introduction: Oral cancer ranks sixth among all cancers globally and India has the most significant number of cases, one-third of the total burden of oral cancer cases globally. The aim of the study was to conduct deep margin assessment using intraoperative ultrasound in superficial oral tongue carcinomas, ensuring adequate surgical resection for early-stage oral tongue cancer minimizing loco regional recurrence risks. Methodology: This is a prospective observational study involving 91 diagnosed tongue malignancies. The study included biopsy verified tongue cancer. During the surgical procedure and effect of general anaesthesia the tongue lesions of the patient were evaluated with intraoral sonography. An intraoral transducer probe characterized by an 8 to 10 MHz ultrasonic beam Siemens Acuson NX3 was used to assess the deep margin, tumor thickness, margins, and other findings like lingual nodes are noted. Results: A total of 91 patients that underwent resection using intraoperative USG were included in the study. The majority of the patients were in the age group 41 - 60 years. As carcinoma tongue is more common in males our study has a sex distribution of 63 male and 28 females. The mean deep margin assessed by USG - is 0.901cm and the mean deep margin assessed by the frozen section is 0.762 cm. The mean deep margin assessed by final histology is 0.748 cm. Conclusion: USG guided resection of early tongue cancers is a technique that is able to increase the frequency of free margins and decrease the close margin and positive margin frequency when compared to conventional treatment. USG being noninvasive is a very fast method in comparison to the frozen section and seems to be a promising technique. Larger studies are needed with control groups to possibly confirm a statistically significant difference in adequate deep resection margin and improvement in DSS and quality of life in future. Keywords: deep margin; tongue; carcinoma

A novel pathological finding, "BABA", for a prognostic factor in oral tongue carcinoma.

92 Background: Oral tongue carcinoma is one of the cancers with poor prognosis. The UICC staging classification is commonly used to predict outcomes and to select the treatments, although there are cases where cancer relapse early despite being at the same Stages, indicating a need for additional prognostic factors to predict patient outcomes accurately. Recent advances in RNA sequencing of tumor and immune cells, as well as elucidation of the tumor microenvironment, have enabled the identification of many genes associated with recurrence risk and immunosuppressive environment around the tumor, which essential for precision treatment of the patients with high risks of recurrence. However pathological findings remain the first step in selecting samples with a high risk of recurrence for further analysis of RNA sequencing or the tumor microenvironment. In this study, we identified a novel pathological feature named as “BABA” (Broadening Amoeboid Behavior of Advanced tumor cells) that appears around the invasive front of tumors. It describes the way in which cancer cells progress like amoeba between muscle fibers and affect the prognosis of oral tongue carcinoma, making it a potential factor for the future analysis of next-generation sequencing or tumor microenvironment. Methods: Patients with oral tongue squamous cell carcinoma who underwent surgery were recruited, excluding those who had received salvage treatment for recurrence, those with simultaneous occurrence of carcinoma, those who had undergone palliative therapy, postoperative therapy, or those who lacked any pathological findings. Survival analyses for existing pathological findings, such as pT (pathological primary stage), pN (pathological nodal stage), ENE (extra nodal extension) status, lymphatic invasion, venous invasion, perineural extension, margin status, WPOI (worst pattern of invasion) and BABA were conducted. Results: A total number of 211 patients were analyzed in this study. Patients with positive for BABA had a two-year overall survival rate and recurrence-free survival rate of 0.78(p=0.02) and 0.39 (p<0.001), respectively, according to Kaplan-Meier analysis. In the multivariate analysis for overall survival using Cox regression model, venous invasion and pN ≥1 were significant prognostic factors, with HR (95%CI) of 3.0 (1.5-6.3) and 2.4 (1.2-4.5), respectively. In the multivariate analysis for recurrence free survival using Cox regression model, positive for lymphatic invasion, venous invasion, BABA, pN ≥1 were significant factors, with HR (95%CI) of 2.1 (1.2-3.6), 2.0 (1.1-3.4), 2.2 (1.3-3.7) and 2.0 (1.2-3.6), respectively. Conclusions: BABA is the novel risk factor for recurrence in oral tongue carcinoma. Identifying BABA could help clinicians better predict recurrence and develop more personalized treatment strategies.

Physical Properties of Meals that are Suitable for Patients after Surgery to Treat Oral Cavity Cancers.

To determine proper characteristics of food which would be safe and satisfactory for swallowing in oral cavity cancer patients undergoing surgery and to create a recipe that provides adequate nutrients, energy, good taste, and can be easily made at home. Patients who were enrolled in this study underwent oral cancer surgery in the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital from September 2017 to July 2018. This experimental research was conducted postoperatively before receiving chemoradiation. Each type of food was prepared by the researchers to have a combination of two physical properties, which were 3 different consistencies (liquid, nectar-like, and honey-like) and 2 different temperatures (room temperature (25ºC) and cold temperature (4ºC)). Each patient had to swallow six different types of prepared food by random sequences. Flexible endoscopic evaluation of swallowing (FEES) was used to evaluate objective swallowing function by 3 parameters, including premature oropharyngeal spillage, laryngeal penetration or aspiration, and post-swallow retaining residues. Satisfaction measurement was evaluated with visual analog scale (VAS). There were 42 postoperative oral cavity cancer patients enrolled in this study. Subjects consisted of 23 males (54.8%) and 19 females (45.2%) with the mean age of 62 ± 13 years. Most patients had oral tongue carcinoma (64.3 %). FEES revealed nectar at room temperature was the safest with score of 0.83 ± 0.82 (possible score of 0-3, with 0 was best). However, patients significantly preferred liquid at room temperature more than other kinds of food (VAS taste = 8.26 ± 1.52 and VAS easy swallowing = 8.05 ± 1.74). When evaluating specifically in patients with oral tongue cancer, FEES scores, VAS taste, and VAS easy swallowing showed similar results the liquid at room temperature was the best. We suggested that the nectar-like thickened food at room temperature was determined to be the most proper food characteristic for oral cancer patients undergoing surgery in order to prevent aspiration. However, patients' satisfaction analysis suggested that they preferred other type of food. The physician should advise patients of the proper kind of food for safe swallowing and avoidance of serious complication especially aspiration pneumonia.

Epigenomic integrative analysis pinpoint master regulator transcription factors associated with tumorigenesis in squamous cell carcinoma of oral tongue.

Head and Neck Cancer (HNC) is a heterogeneous group of cancers, which includes cancers arising in the oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx. Epidemiological studies have revealed that several factors such as tobacco and alcohol use, exposure to environmental pollutants, viral infection, and genetic factors are risk factors for developing HNC. The squamous cell carcinoma of oral tongue (SCCOT), which is significantly more aggressive than the other forms of oral squamous cell carcinoma, presents a propensity for rapid local invasion and spread, and a high recurrence rate. Dysregulation in the epigenetic machinery of cancer cells might help uncover the mechanisms of SCOOT tumorigenesis. Here, we used DNA methylation changes to identify cancer-specific enhancers that were enriched for specific transcription factor binding sites (TFBS), and potential master regulator transcription factors (MRTF) associated with SCCOT. We identified the activation of MRTFs associated with increased invasiveness, metastasis, epithelial-to-mesenchymal transition, poor prognosis, and stemness. On the other hand, we found the downregulation of MRTFs associated with tumor suppression. The identified MRTFs should be further investigated to clarify their role in oral cancer tumorigenesis and for their potential use as biological markers.

Reconstruction of Partial Glossectomy Defects in Patients with Squamous Cell Carcinoma of Oral Tongue: A Prospective Clinical Study on the Assessment and Comparison of Intraoperative and Postoperative Outcomes of Islanded Nasolabial Flap Tunneled Under the Mandible and Radial Forearm Free Flap

Background: Reconstruction of the glossectomy defect following surgery plays a pivotal role in a patient’s quality of life. Reconstruction of surgical defects following glossectomy has evolved greatly from locoregional flaps such as nasolabial, submental, infrahyoid, and pectoralis major myocutaneous flaps to microvascular free flaps (radial forearm free flap [RAFF], anterolateral thigh flap). Due to certain drawbacks, microvascular-free flaps are avoided; instead, local/regional flaps are preferred. Islanded Nasolabial Flap Tunneled Under the Mandible (INFTUM) is a modification of the conventional nasolabial flap based on the facial artery. The flap is raised by dissecting to a certain length to adequately reach a significant distance for reconstruction of the glossectomy defects of mild-to-moderate size. This flap provides adequate bulk and pliable tissue to the remaining tongue, which aids in better functional outcomes. Aim: The aim is to assess and compare the intraoperative and postoperative outcomes of INFTUM and RAFF for the reconstruction of partial glossectomy defects in patients with squamous cell carcinoma of the oral tongue. Materials and Methods: This prospective study was conducted on 20 patients equally divided into two groups, Group A – Islanded Nasolabial Flap Tunnelled Under the Mandible and Group B – RAFF conducted in SGM Cancer Hospital, Sawangi. Intraoperative and postoperative outcomes were evaluated, and statistical analysis was performed using independent sample t-test and Chi-square test where values less than P = 0.05 were found significant. Results: INFTUM flap displayed better intraoperative and postoperative outcomes, especially functional outcomes, in shorter duration as it is locally available with minimum cosmetic deformity to the donor site. In this study, the flap is done in a single stage by tunneling under the mandible. It has a good reach to any aspect of the oral cavity, including the contralateral side, if ipsilateral level Ib nodes are compromised. Conclusion: INFTUM is a simple, effective, and safe flap that can be used for the reconstruction of T2-T3 lesions or partial glossectomy defects. It provides better intraoperative and postoperative outcomes and comparable functional outcomes to RAFF, especially when patients have anesthesia risk for prolonged surgical procedures in a limited-resource setting. Furthermore, it has comparatively less postoperative complications as it has less learning curve.

Comparison between three age-stratified cohorts reveals poor prognosis of young patients with tongue carcinoma.

ObjectivesInvestigation of the prognosis of young patients with tongue carcinoma has been the focus of several recent studies aimed at improving future precision treatment. Most studies have been two-cohort investigations comparing young and older patients, who have wide discrepancies in prognosis. Older patients, especially those aged >70 years, often have a poor general condition. This affects the prognosis of the older cohort and accounts for the discrepancies observed in two-cohort studies. Accordingly, in this study, older patients (aged ≥71 years) were separated and compared to young and middle-aged patients.MethodsA total of 257 patients with oral tongue carcinoma referred during 2011–2017 were analyzed. Patients were sorted into young (aged ≤40 years), middle-aged (aged ≥41 and ≤70 years), and older (aged ≥71 years) groups. Overall survival (OS) and disease-free survival (DFS) were compared among the groups. Furthermore, patterns of recurrence rates were compared.ResultsCompared with young patients, there was no difference in OS or DFS for older patients (hazard ratio [HR]: 1.2, 95% confidence interval [CI]: 0.5–2.7 and HR: 0.7, 95% CI: 0.4–1.2, respectively) in a multivariate analysis. There was also no difference in OS (HR: 0.6, 95% CI: 0.3–1.3) for middle-aged patients. However, middle-aged patients had low recurrence rates (HR: 0.5, 95% CI: 0.3–0.8). With respect to the recurrence type, middle-aged patients had a low local recurrence rate (HR: 0.3, 95% CI: 0.1–0.7).ConclusionThree-cohort studies should be conducted to evaluate whether the prognosis of young patients with tongue carcinoma is truly poor in terms of future precision treatment.

Use of the double-paddle anterolateral thigh flap for locally advanced tongue carcinoma requiring second site reconstruction

BackgroundAdvanced oral tongue carcinoma can present with extension beyond the oral cavity. Operative defects after resection may involve multiple anatomical sites and significantly impact speech and swallowing. Dependence on long-term enteral feeding is not uncommon for these patients. The anterolateral thigh (ALT) flap is one of the most reliable and flexible flaps used in the reconstruction of total and subtotal tongue defects. The double-paddle flap modification may be a more suitable option for complex oral tongue defects after advanced tumor ablation. MethodsCase series of 31 patients with oral tongue squamous cell carcinoma that were classified as stage IV. The age of patients ranged from 32 to 63 years. We designed the double-paddle ALT flaps to reconstruct the two-site surgical defects (tongue defect and pharynx or neck skin defect). Postoperative viability of the flap was checked by clinical observation. The last examination was performed at 3-months after the completion of adjuvant chemoradiotherapy. The functional capacity of our patients was evaluated by three physicians (Head and Neck Surgeon, Radiation Oncologist, and Physiatrist) using a Speech Intelligibility Score and the Functional Oral Intake Scale. ResultsA total of 31 patients with surgical defects after total or subtotal tongue resection for cancer underwent double-paddle ALT flaps for reconstruction from March 2018 to December 2019. The dimension of flaps from 8 × 12 cm to 10 × 18 cm were divided into double-paddle from 8 × 5 cm to 10 × 10 cm. There was one case of pedicle thrombosis, one case of postoperative bleeding, three cases of neck infection, and six cases of salivary fistula. Our patients were seen in follow up from 6 to 36 months, with median follow-up of 23.5 months. The survival rate of ALT flap was 100%. All of our patients achieved an oral diet by 9 months after surgery. The mean score speech intelligibility was 2.74 ± 0.68 (4-point ordinal scale). The 2-year disease-free survival rate was 61.3%. ConclusionsThe double-paddle ALT flap is a reliable flap suitable for oral defects involving multiple subsites after ablative procedures. The majority of patients demonstrated acceptable functional rehabilitation. Clinical question/ level of evidenceTherapeutic, IV.

Induction Chemotherapy in Squamous Cell Carcinoma of Tongue—Still a Slippery Role?

Abstract Background Tongue cancers are more common in the Indian subcontinent and a leading cause of morbidity and mortality among oral cavity cancers. Induction chemotherapy has been considered an intriguing and smart option for many reasons, but even after years of studies and debates, its role has not been fully established in the management of tongue cancers. Materials and Methods In this study, we evaluated 17 patients with oral tongue carcinomas with locally advanced stage, enrolled into a protocol of three drug (docetaxel, cisplatin, 5-fluorouracil) induction chemotherapy for three cycles. After completion of the three cycles, patients were clinically and radiologically re-evaluated and surgery was done if locally operable. Results At the completion of three cycles, five patients were partial responders, four patients were complete responders, and five patients had progressive disease after three cycles. Those patients with response underwent surgery. There were no significant morbid intraoperative or postoperative complications observed in seven out of nine patients. At the end of treatment completion, five out of nine patients had tumor residue/high-risk features and were planned for adjuvant radiotherapy. Conclusion For locally advanced oral tongue carcinomas, the role of induction chemotherapy before surgery has been fruitful and its impact on function preservation with acceptable oncological clearance is an emerging alternative. Spacing chemotherapy and radiotherapy reduce the incidence of adverse effects of combined treatment.

Oral tongue carcinoma: prognostic changes according to the updated 2020 version of the AJCC/UICC TNM staging system.

SUMMARYBackgroundThis study aimed to evaluate the performance of the 2017 8th TNM edition and the latest update in 2020 compared to the 7th in a large cohort of patients affected by oral tongue squamous cell carcinoma (OTSCC), considering all stages.Materials and methodsThe cohort involved 300 patients affected by OTSCC treated with surgery. All cases were classified according to the 7th, 8th (2017), and the latest updated TNM edition (October 2020),. Patients were grouped based on the shift in tumour (T) category, lymph nodal (N) category and final pathological stage. Overall survival (OS) and disease-free survival (DFS) were calculated with the Kaplan-Meier method. Univariate and multivariate analyses were carried out.ResultsAccording to the 7th edition, multivariate analysis OS revealed that stage IV patients had an almost 4-fold risk of death compared to stage I (HR = 3.81 95% CI: 2.32-6.25; p < 0.001). Regarding DFS, stage IV patients had a 2-fold greater risk of relapses, or second primary, than patients in stage I (HR = 2.51 95% CI: 1.68-3.74; p < 0.001). According to 2017 8th edition for OS, stage IV patients presented a 5-fold higher risk of death compared to patients in stage I (HR = 5.18 95% CI: 2.96-9.08; p < 0.001) and almost 4-old greater risk of relapses or second primary compared to patients in stage I considering DFS (HR = 3.61 95% CI: 2.28-5.71; p < 0.001). Regarding the recent edition of 8th TNM (2020), stage IV patients had an almost 5-fold greater risk of death compared to patients in stage I considering OS (HR = 4.84 95% CI: 2.74-8.55; p < 0.001), while for DFS they had 3-fold greater risk of relapse or second primary compared to patients in stage I (HR = 3.13 95% CI: 1.99-4.91; p < 0.001).ConclusionsThis study confirmed that the recent update of the 8th edition of the TNM (2020) improves stratification and identification of advanced tumours, reducing the number of T3 compared to the 2017 edition and increasing the number of patients with pT4. This improvement made by the updated edition may reduce the risk of skipping adjuvant therapy.

Results of sequential swallowing assessments in patients undergoing upfront surgery for oral tongue squamous cell carcinoma

BackgroundThe swallowing outcomes in patients undergoing glossectomy have been inconsistently reported in the literature owing to variable follow up times, different tools for assessment and lack of single institution large scale studies. The aim of our study was to assess the patterns of swallowing outcomes over time and identify factors affecting nasogastric tube dependency at 1-year post-surgery. Materials and MethodsThis was a retrospective study of treatment naïve patients with oral tongue carcinoma who underwent surgery and attended the speech and swallow clinic between January 2016 and December 2019 at our institute were included in the study. The findings of swallowing assessment by a speech language pathologist at three time points were recorded. ResultsA total of 606 patients were found eligible for the study. The median age of the patients was 50 years with the 211 (34.8%) patients having T3/T4 disease. The swallowing outcomes in terms of tube dependence and the spectrum of diet tolerance seem to improve over time with an increasing number of patients switching over to a solid diet by 1 year. A higher defect class (HR = 24.43 [3.48–171.27]) and presence of co-morbidities (HR = 4.17 [1.59–10.92]) were associated with sustained feeding tube dependency status at 1 year. A nomogram was developed based on these findings. ConclusionThe swallowing outcomes in terms of tube dependence and the spectrum of diet tolerance seem to improve over time. A higher defect class and presence of co-morbidities were associated with NGT dependency at 1 year.

Frozen Section Analysis and Real-Time Magnetic Resonance Imaging of Surgical Specimen Oriented on 3D Printed Tongue Model to Assess Surgical Margins in Oral Tongue Carcinoma: Preliminary Results.

BackgroundA surgical margin is the apparently healthy tissue around a tumor which has been removed. In oral cavity carcinoma, a negative margin is considered ≥ 5 mm, a close margin between 1 and 5 mm, and a positive margin ≤ 1 mm. Currently, the intraoperative surgical margin status is based on the visual inspection and tissue palpation by the surgeon and intraoperative histopathological assessment of the resection margins by frozen section analysis (FSA). FSA technique is limited and susceptible to sampling errors. Definitive information on the deep resection margins requires postoperative histopathological analysis.MethodsWe described a novel approach for the assessment of intraoperative surgical margins by examining a surgical specimen oriented through a 3D-printed specific patient tongue with real-time Magnetic Resonance Imaging (MRI). We reported the preliminary results of a case series of 10 patients, prospectively enrolled, with oral tongue carcinoma who underwent surgery between February 2020 and April 2021. Two radiologists with 5 and 10 years of experience, respectively, in Head and Neck radiology in consensus evaluated specimen MRI and measured the distance between the tumor and the specimen surface. We performed intraoperative bedside FSA. To compare the performance of bedside FSA and MRI in predicting definitive margin status we computed the weighted sensitivity (SE), specificity (SP), accuracy (ACC), area under the ROC curve (AUC), F1-score, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). To express the concordance between FSA and ex-vivo MRI we reported the jaccard index.ResultsIntraoperative bedside FSA showed SE of 90%, SP of 100%, F1 of 95%, ACC of 0.9%, PPV of 100%, NPV (not a number), and jaccard of 90%, and ex-vivo MRI showed SE of 100%, SP of 100%, F1 of 100%, ACC of 100%, PPV of 100%, NPV of 100%, and jaccard of 100%. These results needed to be validated in a larger sample size of 21- 44 patients.ConclusionThe presented method allows a more accurate evaluation of surgical margin status, and the first clinical experiences underline the high potential of integrating FSA with ex-vivo MRI of the fresh surgical specimen.

Factors predicting the perineural invasion in carcinoma oral cavity.

This study to evaluate clinicopathological parameters such as age, tumor location, tumor size, grade, depth of invasion (DOI), lymphovascular space invasion (LVSI), lymph node metastasis, and stage that predict peri-neural invasion (PNI) in oral squamous cell carcinoma (OSCC). A retrospective study on 1716 postoperative OSCC patients who satisfied the eligibility criteria and treated from January 2009 to December 2019 was analyzed using IBM SPSS V23. Mean and percentage were assessed using descriptive statistics. Wilcoxon-Mann-Whitney U-test was used to compare continuous variables, while Chi-square test was used to compare discrete variables between PNI-positive and PNI-negative groups. Two-tailed P < 0.05 was considered to be statistically significant. Out of 1716 patients, 553 were PNI positive. The mean age was 48.76 ± 12.42 years in PNI-positive patients while 51.52 ± 12.51 years in PNI-negative patients. Males outnumbered females. The most common primary was carcinoma buccal mucosa (204, 36.9%), followed by carcinoma of oral tongue (161,29.1%). Maximum tumor size was 3.14 ± 1.20 cm in PNI-positive patients whereas 2.78 ± 1.22 cm in PNI-negative patients. Sixty (10.84%) patients in PNI-positive group and 51 (4.38%) in PNI-negative group had LVSI positive. Lymph node involvement was observed in 305 (55.13%) patients in PNI-positive group whereas 358 (30.78%) patients in PNI-negative group. Maximum number 228 (41.3%) in PNI-positive patients were in Stage IVA disease. PNI is one of the important adverse prognostic factors having a definite correlation with anatomical subsite, tumor size, grade, DOI, LVSI, lymph node involvement, and stage of the disease. PNI should be analyzed in postoperative histopathology report of OSCC that guides the clinician for adjuvant therapy.

Role of Selective Neck Dissection in Primary T&lt;sub&gt;1&lt;/sub&gt;, T&lt;sub&gt;2&lt;/sub&gt;, N&lt;sub&gt;0&lt;/sub&gt; Neck Oral Tongue Carcinoma

Background: Oral tongue is one of the common site for carcinoma. 22% to 39% of oral cancer develops at this site. The high incidence of cervical lymph node metastasis, occult cervical metastasis, Provide a logical basis for treatment of the neck. The aim of this is study was to find out the importance of selective neck dissection in primary T1, T2, N0 Neck Oral Tongue Carcinoma. Methods: This cross-sectional study was conducted in the Department of Otolaryngology- Head &amp; Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital and National Institute of ENT, Dhaka. Thirty cases of primary T1, T2, N0 Neck Oral Tongue Carcinoma with inclusion criteria was enrolled as a study sample. Patients were evaluated by a complete clinical head and neck examination as well as Imaging (MRI) of the primary tumor and neck. All the data were compiled and sorted properly and the numerical data were analyzed statistically. The results were expressed as percentage and mean ± SD. Chi-square (x2) test or Fisher’s Exact test was done for comparison of data presented in categorical value and p value &lt;0.05 was considered as the level of significance. Among the patients 23(76.7%) were T1 lesion and remaining 7(23.33%) were T2 lesion. Extended Supraomohyoid Selective Neck Dissection (SOSD) (I-IV) was done in all patients. Following histopathological examination, 8(26.67%) patients of N0 neck became positive for nodal metastasis. Results: The study showed that most commonly (50%) involved group of occult metastasis was upper deep cervical lymph node in submandibular area (level-I). Occult nodal metastasis was significantly common 87.5% among male patients than females (p=0.039) and also common 87.5% among &lt;50 years age group (p=0.023). Neck node positive was significantly more 62.5% in T2 lesion (p=0.002) of oral tongue carcinoma. Conclusion: In this study, we found that a number of patients had been histopathologicallly detected micro-metastases in regional neck nodes in clinically N0 patients.So, Extended Supraomohyoid Selective neck dissection (I-IV) was appropriate in T1,T2, N0 Neck Oral Tongue Carcinoma. Bangladesh J Otorhinolaryngol 2021; 27(2): 130-138

Inter-Correlations Between Various High-Risk Pathological Factors in Resected Buccal Mucosal Squamous Cell Carcinoma

<h3>Purpose/Objective(s)</h3> While exploring histopathological high-risk factors for squamous cell oral cancer most studies have included oral tongue as major subsite in their patient population. Buccal mucosal squamous cell carcinoma (BMSCC) being rare in developed countries is a less studied site in this regard. Hence most of the knowledge we have about high-risk factors of BMSCC is extrapolated from oral tongue carcinoma. The objective of this study was to explore inter-correlations between various pathological high-risk factors found in resected specimen of BMSCC. <h3>Materials/Methods</h3> It was a retrospective analysis in which we reviewed the final histopathology of surgical specimen of 150 patients with BMSCC who had undergone upfront surgical resection followed by adjuvant therapy. Various high-risk factors studied were pT Stage, pN Stage, depth of invasion (DOI), grade, perineural invasion (PNI), lymphovascular invasion (LVI), tumor thickness (TT), worst pattern of invasion (WPOI), and extranodal extension (ENE). Inter-correlations were performed between various pathological factors using Spearman's correlation test. <h3>Results</h3> Inter-correlation between various factors were found and shown in Table. <h3>Conclusion</h3> pT stage showed significant positive correlation with pN stage, TT, DOI, PNI, nodal deposit size and with ENE. pN stage showed significant positive correlation with pT stage, PNI, LVI, WPOI and ENE. PNI showed significant positive correlation with pT stage, pN stage, nodal deposit size, ENE, LVI, DOI, TT, WPOI. LVI showed significant positive correlation with PNI, WPOI, pN stage, nodal deposit size and ENE. DOI showed significant positive correlation with pT stage, PNI, TT. TT showed significant positive correlation with pT stage, PNI and DOI. WPOI showed significant positive correlation with pN stage, frozen section margin, PNI, LVI and ENE. ENE showed significant positive correlation with pT stage, pN stage, PNI, LVI and WPOI. Grade, configuration and margin status of the tumor showed no significant association with any of the histopathologic variable. Many of these correlations are not shown in oral tongue cancer in most studies. Hence, it is appropriate that intercorrelation between these factors in BMSCC should be dealt differently than in oral tongue cancer. BMSCC may have different biology than oral tongue cancer.

Multiple Tobacco Related Lesions with Squamous Cell Carcinoma – A Case Report

Oral squamous cell carcinoma is the most commonly occurring malignant disease worldwide. The oral squamous cell carcinoma shares clinical similarity with various forms of inflammatory gingival lesions and is often misdiagnosed in our routine dental practice. Oral tongue carcinomas represent approximately 25% of oral cavity carcinomas. These lesions are characterized by early infiltration into the underlying tongue musculature with an early and high risk for regional metastases. The dentist should have precise knowledge regarding the clinical manifestation of this deadly disease as early diagnosis and prompt treatment. Early detection of such lesions can help in reducing morbidity and mortality. Keywords: Oral squamous cell carcinoma, tongue malignancy, OSCC, clinical course, tobacco related lesions, leukoplakia, oral submucous fibrosis, smoker’s melanosis

The utility of intra-oral ultrasound in improving deep margin clearance of oral tongue cancer resections

ObjectivesTo investigate the potential utility of intra-oral ultrasound (IOUS) in guiding deep margin clearance and measuring depth of invasion (DOI) of oral tongue carcinomas (OTC). Materials and MethodsRetrospective chart review of consecutive patients with T1-T3 OTC who underwent intraoperative ultrasound-guided resection and a comparator group that had undergone resection without the use of IOUS both by a single surgeon. Data was extracted from operative, pathology and radiology reports. Deep margins and DOI were reviewed by a dedicated head and neck pathologist. Correlation between histologic and ultrasound DOI was assessed using Pearson correlation. ResultsA total of 23 patients were included in the study cohort with a comparator group of 21 patients in the control group. None of the patients in the study cohort had a positive (cut-through) deep margin and the mean deep margin clearance was 8.5 ± 4.9 and 6.7 ± 3.8 for the IOUS and non-IOUS groups respectively (p-value 0.18) showing a non-significant improvement in the IOUS group. As a secondary outcome, there was a strong correlation between histologic and ultrasound DOI (0.9449). ConclusionUltrasound appears to be a potentially effective tool in guiding OTC resections. In this small series, IOUS facilitated deep margin clearance and resulted in a non-statistically significant increase in deep margin clearance. Intraoral ultrasound can accurately measure lesional DOI.

Pattern and localization of perineural invasion predict poor survival in oral tongue carcinoma.

Survival rate for oral tongue squamous cell carcinoma (OTSCC) is still poor and, despite Tumor-Node-Metastasis staging system has been recently updated, patients included under the same stage still show difference in prognosis. Perineural invasion (PNI) emerged to be an indicator of tumor aggressive behavior and unfortunate events. In this study, we investigate the clinic and prognostic value of PNI in a cohort of OTSCC patients. About 200 patients with OTSCC were retrospectively evaluated the presence of PNI. PNI was furtherly descripted as uni-/multifocal and as intra-/peritumoral. Disease-Specific and Relapse-Free Survival (DSS; RFS) were estimated; moreover, we included PNI in the current AJCC 8th Staging System, improving the prognostication model. Perineural invasion was found in 40.5% of patients. Intratumoral PNI predicted patients at high risk of being diagnosed with lymph-node metastasis. Tumors with positive PNI reported a worse DSS (Hazard Ratio=1.878, p-value=0.008). Moreover, patients exhibiting both multifocal intra- and peritumoral PNI reported poorest DSS (Hazard Ratio=2.409, p-value=0.010). Patients were reclassified in a new staging system in case of multifocal PNI, providing better stratification capacity. Perineural invasion might serve as an additional prognostic factor in OTSCC, and by integrating PNI in the staging system, further improvements in prognostication might be reached.