Partial Glossectomy Research Articles

Digital optimization of teeth setup in an edentulous patient with partial glossectomy: A case report.

The purpose of this clinical report was to describe the use of a piezographic impression associated with computer-aided design and computer-aided manufacturing (CAD-CAM) for teeth setup and of digital tools for neuro-musculo-kinetic analyses. An edentulous patient with hemiglossectomy and heavily resorbed mandible consulted for complete denture rehabilitation to improve their masticatory function and speech. Master casts, wax rims, and piezographic impression were scanned for digital prosthetic work. Two digital try-ins were performed to respect the neutral zone: try-in 1 with posterior crossbite and try-in 2 without crossbite. Muscle activity and mandibular kinetics were performed for each try-in following the MAC2 protocol (six criteria): muscular tone, contraction synchrony, contraction efficiency, interocclusal rest distance, amplitude of mandibular movement, and velocity. Try-in 2 showed better data than try-in 1 in all criteria: muscle tone (respectively 71% vs. 59%), contraction synchrony (79% vs. 75%), contraction efficiency (85% vs. 77%), an increase in range of motion of 3.3mm, and a better velocity (0.35±0.12s vs. 0.57±0.14s, p=0.008). The piezographic impression, in combination with CAD-CAM, allowed the comparison of two prosthetic designs and the selection of the try-in with the best neuro-musculo-kinetic results.

Significant association of Yamamoto-Kohama classification and pathological depth of invasion with cervical lymph node metastasis in early-stage tongue squamous cell carcinoma (Stage I/II)

Background/purposeTongue squamous cell carcinoma (SCC) has a poor prognosis due to a high rate of cervical lymph node metastasis (CLNM). We aimed to determine clinicopathological features related to the prediction of CLNM in tongue carcinomas (Stage Ⅰ/Ⅱ). Materials and methodsData from 89 patients with tongue SCC (Stage I/II) were analyzed retrospectively. Patients were treated only with partial glossectomy and not with chemotherapy or radiotherapy until CLNM was observed. No cervical lymph node metastasis survival (NCLNMS) was estimated using the Kaplan–Meier method. The difference in NCLNMS between the groups with and without CLNM was compared using the log-rank test. The Cox regression model was used to estimate hazard ratios and the associated 95% confidence interval. ResultsClinical T2, clinical and pathological depth of invasion (cDOI and pDOI, respectively) > 5 mm, Yamamoto-Kohama (YK)-4c, tumor budding ≥5, worst pattern of invasion −4/5, muscle invasion, perineural invasion, and grade of differentiation 3 were found to be significant CLNM risk factors. ConclusionCLNM was observed in 25.8% of early-stage tongue carcinomas (Stage I/II). YK-4c and pDOI >5 mm were the most important CLNM risk factors identified. Close follow-up is needed after partial glossectomy when patients with tongue SCC have other risk factors, particularly YK-4c and pDOI >5 mm.

The Efficacy of the Partial Glossectomy for Prevention of Airway Volume Reduction in Orthognathic Surgery of Class III Patients

The aim of this study was to evaluate the effects of a partial glossectomy on volumetric changes of pharyngeal airway space (PAS) in patients with mandibular setback surgery. Overall, 25 patients showing clinical features related to macroglossia treated with mandibular setback surgery were included in this retrospective study. Subjects were divided into two groups: the control group (G1, n = 13, with BSSRO) and the study group (G2, n = 12, with both BSSRO and partial glossectomy). The PAS volume of both groups was measured by the OnDemand 3D program on CBCT taken shortly before operation (T0), 3 months post-operative (T1), and 6 months post-operative (T2). A paired t-test and repeated analysis of variance (ANOVA) were used for statistical correlation. Total PAS and hypopharyngeal airway space were increased after operation in Group 2 compared to Group 1 (p < 0.05), while oropharyngeal airway space showed no significant statistical difference with the tendency of increasing. The combination of partial glossectomy and BSSRO surgical techniques had a significant effect on increasing the hypopharyngeal and total airway space in class III malocclusion patients (p < 0.05).

Matrix for Mucosal Regeneration in Transoral Glossectomy for Squamous Cell Carcinoma: Objective and Subjective Functional Evaluation.

Numerous options to manage local reconstruction following transoral partial glossectomy are possible. In this work, we present our experience using a matrix for mucosal regeneration, Integra®, after transoral resections of squamous cell carcinoma of the oral tongue. A retrospective analysis of patients treated for tongue carcinoma and reconstruction with Integra®, from September 2017 to September 2022. Functional outcomes were evaluated by measuring swallowing and speech abilities, tongue motility, and subjective quality of life. The series accounts for 13 consecutive patients, staged from Tis to T3, no positive resection margins were found, average defect size was 17.8 cm2. The average histologically measured depth of invasion was 4.1 mm (range 2-12 mm), and no recurrences were observed during follow-up. All patients maintained excellent swallowing function, the average number of recognized words by an external listener during a phone call was 70.5 out of 75, the lingual motility test was good (a mean score of 4.5 out of 6 movements correctly executed) and subjective questionnaires results were optimal. Less satisfying functional results were recorded in elderly patients receiving a wider surgical resection. This reconstructive technique for allows obtaining optimal healing and functional outcomes in patients with tumors suitable for transoral glossectomy.

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.

Pre-resection Intraoperative Core Biopsies in Oral Tongue Cancer-A Pilot Study.

To assess a novel intraoperative core biopsy technique to provide enhanced guidance in partial glossectomies. All patients diagnosed with squamous cell carcinoma of the oral tongue were eligible for study participation. Following anesthesia, the planned resection and three points midway between the gross tumor and the intended ablation were marked. A core biopsy was performed with a needle spring on each point and sent for frozen sections. The initially planned resection was executed if the cores returned free of tumor. In case of a positive core biopsy, a new 1-1.5 cm margin was marked around that point. The main outcome measure was the closest final margin diameter, especially the deep ones. Other outcome measures were the core biopsies' sensitivity, specificity, and negative predictive value. Complications were recorded. The final margins of 10 patients undergoing intraoperative core biopsies and 20 matched controls were analyzed. One patient had two positive cores and final negative margins after modifying the resection accordingly. Another patient had a positive biopsy diagnosed only on final pathology, and one close final margin. Patients that were operated with the new technique had larger margins compared to the controls: median (interquartile range) closest margin 5.95 (3.97; 9.63) mm versus 4 (2.25; 5) mm (p =0.074) and median deep margin 8.6 (6.16; 10) mm versus 5 (3;10) mm (p =0.411), respectively. There were no complications. A novel pre-resection intraoperative biopsy technique is presented. Core biopsies taken during glossectomies have the potential to prevent inadequate margins. 3 Laryngoscope, 133:2232-2236, 2023.

Anesthetic management with remimazolam in a patient with Child-Pugh C liver cirrhosis: a case report

BackgroundRemimazolam is a new ultra-short-acting benzodiazepine, and its sedative effect is prolonged in patients with hepatic impairment. This is the first report of remimazolam anesthesia in a patient with Child-Pugh C liver cirrhosis.Case presentationA 52-year-old female was diagnosed with tongue cancer and scheduled for partial glossectomy. Preoperative examinations revealed Child-Pugh C liver cirrhosis, but the pathogenesis was unknown. We scheduled remimazolam anesthesia because it would stabilize her intraoperative circulation. We managed with a much lower-than-normal dose of remimazolam; even so, the patient required flumazenil to regain consciousness. She was admitted to the intensive care unit, but her consciousness remained clear even after the effect of flumazenil had worn off.ConclusionWe experienced anesthetic management with remimazolam in a patient with Child-Pugh C liver cirrhosis. Even conservative use of remimazolam in patients with severe hepatic dysfunction may result in emergence times that are delayed longer than expected.

Multidetector computed tomography (MDCT) angiography in the evaluation of external carotid artery

BackgroundKnowledge about anatomical variants of the external carotid artery is crucial in head and neck surgery and interventional technique. This work aimed to present the frequency of regular and another variant of the external carotid artery using 128 multidetector computed tomography (MDCT) angiography. Materials and methodsThis retrospective study included 120 patients in our university hospital between April 2017 and October 2021. They were 65 men and 55 women (mean age, 45.6 years; range, 18-65 years). They were angiofibroma (10 patients), cerebral stroke (28 patients), partial glossectomy (13 patients), submandibular gland excision (12 patients), parotidectomy (17 patients), mandibulectomy (5 patients), and a thyroidectomy (35 patients). We retrospectively analyzed the level and branches of external carotid arteries on both sides of 120 patients. ResultsAccording to the level of bifurcation; the external carotid artery originated at the level of the upper border of the thyroid cartilage in 164/240 cases (68.3%), and a higher level was detected in 76/ 240 cases (31.7%). The lower level of origin of the external carotid artery was not detected. The superior thyroid, facial, and lingual arteries originated from separate branches of external carotid arteries in 173/240 cases (72.1%). At the same time, the facial arteries originated with lingual arteries in a common trunk in 67/240 cases (27.9%). ConclusionMDCT angiography is a valuable noninvasive diagnostic tool for evaluating the external carotid artery and its branches.

Taming the Tongue: The Surgical Approach to Macroglossia.

While traditionally in the realm of otorhinolaryngology or oral maxillofacial surgery, conditions involving the tongue may also be managed by plastic surgeons. The authors present an unusual case of acquired macroglossia resulting from angiotensin-converting enzyme inhibitor-induced angioedema and review the literature to discuss its surgical management from a plastic surgery perspective. A 62-year-old female suffered severe airway obstruction, respiratory arrest, and anoxic brain injury from angioedema-associated macroglossia. After tracheostomy, the patient was managed nonsurgically, with bite wound care and medications to minimize angioedema to marginal effect. Ultimately, a partial glossectomy was planned. The edematous distal tongue was amputated and closed primarily. On postoperative day 2, she was successfully weaned off mechanical ventilation and no longer suffers trauma from tongue biting. The simple anterior tongue resection described in this paper was an appropriate approach for our patient. More research is needed to guide plastic surgeons in an optimal approach for clinical scenarios.

Partial Glossectomy Combined With Radiofrequency Ablation for Macroglossia in Beckwith-Wiedemann Syndrome.

As the most common feature of Beckwith-Wiedemann syndrome (BWS), macroglossia may influence the quality of life, maxillofacial growth, and speech development of children. The retrospective study aimed to investigate the therapeutic effect of partial glossectomy combined with radiofrequency ablation (RFA) for macroglossia patients in BWS. A retrospective study was conducted in BWS-derived macroglossia patients who underwent partial glossectomy combined with RFA from May 2019 to January 2021. In total, 35 patients consisting of 17 males and 18 females met the inclusion criteria and underwent surgery by the same plastic surgeon. Demographic characteristics, BWS features, operation details, preoperative and postoperative outcomes, satisfaction evaluations, and subgroup analysis were collected and assessed. Of the 35 patients involved, the average age at the time of surgery was 14.05±8.08 months, and the average surgery duration was 48.17±6.72 minutes. Only 1 patient suffered ventral tongue wound dehiscence, and the rest of the patients did not develop any other complications. The severity and frequency of tongue protrusion, drooling, snoring, and feeding difficulty were significantly ameliorated. The patient's parents showed satisfaction towards the overall surgery, tongue's appearance, and tongue's motor function. Tongue's height decreased from 32.09±1.16mm before the operation to 29.29±1.33mm after the operation. The partial glossectomy combined RFA exerts a safe, effective and viable technique to treat BWS-derived macroglossia.

Quality of Life and Aesthetic Satisfaction in Patients Who Underwent the "Commando Operation" with Pectoralis Major Myocutaneus Flap Reconstruction-A Case Series Study.

The “commando operation” is an extensive surgical procedure used to treat patients with oral squamous carcinoma and metastasis in the cervical lymph nodes. While the procedure can be curative, it is also very mutilating, which consequently has a major impact on the patient’s quality of life. Several studies showed that the procedure is associated with loss of certain functions, such as impairments in speech, chewing, swallowing, and loss of taste and appetite. Furthermore, some of these impairments and their degree depend on the reconstruction method. However, the data regarding the functional impairments and aesthetic results in patients who underwent the “commando operation” along with the pectoralis major myocutaneus flap reconstruction are still inconclusive. This study included 34 patients that underwent partial glossectomy, ipsilateral modified radical neck dissection, pectoralis major myocutaneus flap reconstruction, and adjuvant radiotherapy. A structured questionnaire was used to evaluate aesthetical results and functional impairments as well as to grade the level of satisfaction with the functional and aesthetic outcomes both by the patients and by the operator. Most of the patients stated that their speech (N = 33; 97%) and salivation (N = 32; 94.2%) severely changed after the operation and that they cannot chew (N = 33; 97%) and swallow (N = 33; 97%) the same as before the operation. Moreover, almost half of the patients (N = 16; 47%) reported that they have severe sleep impairments. However, only few of the included patients stated that they sought professional help regarding the speech (N = 4; 11.7%), eating (N = 5; 14.7%), and sleeping (N = 4; 11.7%) disturbances. Additionally, there was a statistically significant difference between the operator and the patients in the subjective assessment of the aesthetic results (p = 0.047), as operators gave significantly better grades. Our results imply that this procedure and reconstructive method possibly cause impairments that have an impact on the patients’ wellbeing. Moreover, our outcomes also suggest that patients should be educated and rehabilitated after the “commando operation” since most of them were reluctant to seek professional help regarding their impairments. Lastly, sleep deficiency, which was observed after the procedure, should be further explored.

Management of MACROGLOSSIA: Case Series and Suggested Algorithm

Idiopathic macroglossia is a rare entity of true tongue enlargement without an underlying etiology. There are only a few case reports on the diagnosis and management of idiopathic macroglossia. This study's purpose was to present a series of patients with idiopathic macroglossia and suggest a treatment algorithm. This was a retrospective case series of a cohort of patients with macroglossia who were treated by the Oral and Maxillofacial Surgery service at the University of Texas Health Science Center at Houston (UTHealth)and Emory University. The patient's medical comorbidities, history of present illness, clinical presentation, radiographic findings, and disease management were studied. The outcome variables include normalization of the tongue size, dependence on parenteral nutrition, and tolerating tracheostomy decannulation. Five patients with a mean age of 45years were included in the study. All of the patients (n=5, 100%) in our cohort developed macroglossia following prolonged oral intubation, with 3.5weeks being the average length of intubation. All patients presented with difficulty feeding orally and breathing. The average tongue dimension was 12.20 x 6.25cm. All tongue enlargements were located in the anterior 2/3 of the tongue, and all patients had displaced anterior dentition. In addition, 60% of the patients (n=3) experienced altered tongue sensation (pain and/or decreased taste). These patients were surgically managed with tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement followed by partial glossectomy (n=5, 100%). We defined successful outcomes as 1) modifying the tongue to a functional, nonprotruding form, 2) tracheostomy decannulation and 3) PEG tube removal. Tracheostomy decannulation and PEG tube removal were achieved in 80% of the patients (n=4). In this patient cohort, we were unable to identify the cause of the pathology based on existing clinical data. When the etiology is unclear or irreversible, management should involve tracheostomy and surgical feeding access for the initial stabilization, followed by modified glossectomy to improve form, function, and cosmesis thereby improving the overall quality of life.

What is Idiopathic Macroglossia? A case series and review of literature

<h3>Purpose</h3> Macroglossia is pathological condition which resulted in hypertrophy of tongue muscles. It is classified into congenital and acquired macroglossia. Idiopathic macroglossia (IM) is tongue hypertrophy without systemic or genetic causes. This condition has a significant impact on the quality of life, and often require tracheostomy and percutaneous endoscopic gastrostomy (PEG) to sustain living. Guidelines regarding treatment for this subtype are scant. The purpose of this project to present diagnosis and management of a series of patients with idiopathic macroglossia. <h3>Methods</h3> This was a retrospective case series of a cohort of patients with IM who were treated by Oral and Maxillofacial Surgery (OMS) service at University of Texas Health Science Center in Houston (UTHealth) and Emory University from 2019 to 2021. Inclusion criteria are (1) 18 years or older, (2) diagnosed with macroglossia, (3) managed with surgery, (4) with normal tongue tissue on histopathology results, and (5) with a negative COVID test. Patients were excluded if they are younger than 18 years old and diagnosed with macroglossia due to an underlying etiology such as congenital anomaly, systemic conditions, and intraoral inflammatory changes. Study variables were patient demographics, social history, medical comorbidities, clinical presentation, clinical dimensions, presence of tongue protrusion, difficulty feeding, difficulty in breathing, imaging characteristics/dimensions, pathological findings, management (tracheostomy, PEG, glossectomy), and length of inpatient stay. The outcome variables were normalization of tongue size, return of parenteral nutrition, and able to tolerate tracheostomy decannulation. Data were collected using a standardized collection form. Descriptive statistics were computed. <h3>Results</h3> Five patients (mean age, 45 years) with IM met inclusion criteria. All patients had history of hypertension, cerebral vascular disease, and prolong intubation. All patients presented with anterior tongue enlargement, with mean dimension of 13 × 6 cm, full or partial dentition, altered tongue sensation. They were all managed with tracheostomy to secure the airway, PEG and partial glossectomy. Average length of inpatients stay was 10 days. All IM achieved clinical resolution, 80% of the patients had their tracheostomy decannulated and PEG tube removed. <h3>Conclusion</h3> Management of macroglossia requires multidisciplinary approach. While etiology can often be identified and medical treatment can be initiated for reversible causes, most of the macroglossia cases previously reported required surgical management. Surgical reduction offers the best functional and cosmetic results and minimizes morbidity. In the case idiopathic macroglossia, management should involve tracheostomy and feeding access for the initial stabilization followed by reduction glossectomy for improvement of functional outcomes.

BECKWITH-WIEDEMANN SYNDROME: A CASE REPORT

Beckwith-Wiedemann syndrome (OMIN130650) is a rare congenital condition (1/13,500 natives) characterized by hypergrowth, autosomal dominant inheritance, and gene dysregulation in the 11p15 chromosomal region. The diagnosis is made during the neonatal or postnatal period, when the affected fetus tends to grow at an accelerated pace in the second half of pregnancy and first years of life. The main features are gigantism, omphalocele, abdominal wall defect, renal dysplasia, and macroglossia. Macroglossia affects 88% to 99% of cases, interfering with the development of the face and leading to respiratory, swallowing, chewing, phonation, and mandibular hypertrophy disorders. Craniofacial dysfunctions induced by macroglossia can be treated in early childhood with partial glossectomy. A 12-year-old male patient sought dental care, without complaint of painful, presenting macroglossia, prognathism, open bite, and no glossectomy history. Orthodontic treatment was performed with a palate expander. According to the patient, the treatment improved sleep, phonation, and weight gain.

AGGRESSIVE PRIMARY INTRAOSSEOUS CARCINOMA AMELOBLASTOMA-LIKE INVOLVING ANTERIOR REGION AND MANDIBULAR BODY: CASE REPORT

Primary intraosseous carcinoma of the jaw is a rare malignant tumor with poor prognosis. A 66-year-old male smoker presented with swelling in the anterior region and right body mandibular, with extraoral fistula and palpable cervical lymph nodes. Intraoral examination evidenced an ulceration with a hard consistency. Panoramic radiograph and computed tomography revealed a large lesion with bone destruction in the region. After incisional biopsy, microscopic examination revealed a proliferation of epithelial cells sometimes similar to squamous cells, forming keratin pearls, or similar to the odontogenic epithelium, arranged in nests and islands of basaloid cells with peripheral palisading. Atypia, pleomorphism, and mitoses were observed, leading to the diagnosis of primary intraosseous carcinoma ameloblastoma-like. The patient underwent mandibulectomy, partial glossectomy, and removal of the floor of the mouth muscles. Follow-up is still being carried out and 1 month after surgery the patient is in stable condition without pain.

SQUAMOUS CELL CARCINOMA IN A 16-YEAR-OLD PATIENT: A CASE REPORT

Squamous cell carcinoma is the most common oral malignant neoplasm, occurring mainly in individuals over 45 years old. A 16-year-old girl sought dental care, complaining of a tongue wound and reporting frequent trauma at the site. A prior diagnosis of acute lymphoid leukemia at the age of 6 years, treated with chemotherapy, was reported. On intraoral examination, an ulcerated lesion was observed at the left border of the tongue, with an irregular shape and high, hardened edges, measuring 5 mm. An incisional biopsy was performed and the histopathologic analysis confirmed an oral squamous cell carcinoma. Additional immunohistochemistry tests for p16 were performed, showing negative result, and magnetic resonance imaging confirmed the expansive infiltrative lesion without cervical lymph nodes. The patient was submitted to partial glossectomy without neck dissection. After 2 months, the patient remains with no signs of lesion recurrence.

SURGICAL MAPPING OF EXTENSIVE POTENTIALLY MALIGNANT ORAL DISORDER WITH TOLUIDINE BLUE STAIN: A CASE REPORT

A 66-year-old male patient who was an ex-smoker and ex-drinker presented with a main complaint of "tongue pain" for 6 months. Physical examination revealed an extensive heterogeneous plaque with mixed white and red patches, irregular borders, and with the largest diameter of 5 cm, located at the left lateral border of the tongue and floor of mouth. Based on the characteristics of the lesion, the clinical diagnosis was leukoplakia. The lesion was mapped using the toluidine blue stain; 4 areas were stained positive, and 2 areas were subjected to incisional biopsy. Histopathologic analysis revealed epithelial dysplasia and squamous cell carcinoma. The definite diagnosis was squamous cell carcinoma. The patient was referred to the head and neck surgery service, where he underwent partial glossectomy and is being followed up with no evidence of recurrence. Toluidine blue stain is important for selection of the incisional biopsy area in extensive heterogeneous lesions suspected of potentially malignant oral disorders and oral cancer.

Comparison between the radial forearm and superficial circumflex iliac artery perforator free flaps for oral soft tissue reconstruction

The radial forearm free flap (RFFF) is widely used for oral reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap is an increasingly utilized alternative. The cases of 165 patients who received either an RFFF or SCIP flap for oral reconstruction at Chris O′Brien Lifehouse, Sydney were reviewed. The aim was to report on patient, pathology, treatment, and outcome variables and to compare these between the two flap groups. A RFFF was used in 126 patients and a SCIP flap in 39 patients. SCIP flap patients were younger (P < 0.001) and had shorter operative times (P < 0.001), shorter anaesthetic times (P < 0.001), and more frequent recipient site dehiscence (P = 0.005) when compared to RFFF patients. The SCIP flap was significantly less frequently used for composite resections including bone when compared to the RFFF (P < 0.001). The primary site distribution was more even for RFFF patients (P < 0.001). There were no SCIP flap failures; three RFFF failures occurred. SCIP flaps performed comparably in terms of operative and clinical outcomes. Most SCIP flaps were utilized in younger patients with partial glossectomy defects.

Feasibility of accelerated image-guided high-dose-rate interstitial brachytherapy with inverse planning simulated annealing (IPSA-HDRBT) for post-operative treatment of pathologically node-negative squamous cell carcinomas of the oral tongue

Inverse planning simulated annealing (IPSA) produces highly conformal dose distributions and quick optimizations for high-dose-rate interstitial brachytherapy (HDRBT). We report our dosimetry and overall outcomes using this approach for the accelerated post-operative treatment of pathologically node-negative squamous cell carcinomas of the oral tongue (OTSCC) with high risk of local recurrence. Patients with newly diagnosed pN0 OTSCC treated with partial glossectomy, neck dissection, and post-operative HDRBT alone from 2007 to 2021 were retrospectively reviewed. Patients received 30 Gy in 5 fractions over 2.5 days. Target volume and mandible dosimetry are reported. Actuarial rates of local control, regional control, disease-specific survival, and overall survival were estimated using the Kaplan-Meier method. Toxicity was categorized using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. 19 consecutive patients were reviewed. Median follow-up was 3.2 years (IQR 1.4-8.2 years) with a 3-year estimated local control rate of 81%. Target volumes were generally small, as the median volume was 12.66 cc. Median V150% and V200% were 52% and 24%, respectively. D1cc and D2cc to the mandible were 17.31 Gy and 14.42 Gy, respectively. IPSA-HDRBT is feasible and highly efficient for post-operative treatment of the primary tumor bed in patients with pathologically node-negative squamous cell carcinomas of the oral tongue. Further technical optimization and prospective clinical evaluation in a larger patient cohort are planned.

Variation in the Price of Head and Neck Surgical Oncology Procedures.

Health care costs can present a significant strain on patients with head and neck cancer. It remains unclear how much prices may vary among hospitals providing care and what factors lead to differences in prices of surgical procedures. A cross-sectional analysis of private payer-negotiated prices was performed for 10 commonly performed head and neck surgical oncology procedures. In total, 896 hospitals disclosed prices for at least 1 common head and neck surgical oncology procedure. Wide variation in negotiated surgical prices was identified. Across-center ratios ranged from 6.2 (partial glossectomy without primary closure) to 22.8 (excision of tongue lesion without closure). For-profit hospital ownership structure and geographic region outside of the northeast United States were associated with increased prices. For example, private payer-negotiated prices for direct laryngoscopy with biopsy were on average $2083 greater at for-profit hospitals when compared with nonprofit hospitals ($5215 vs $3132, P < .001). Further research comparing prices and outcomes is needed.