Tongue Cancer Surgery Research Articles

Voice Rehabilitation after tongue cancer surgery: a cohort study in indian population

Voice Rehabilitation after tongue cancer surgery: a cohort study in indian population

Feasibility of a Novel 3D Ultrasound Imaging Technique for Intraoperative Margin Assessment during Tongue Cancer Surgery.

Squamous cell carcinoma (SCC) of the tongue is the most prevalent form of oral cavity cancer, with surgical intervention as the preferred method of treatment. Achieving negative or free resection margins of at least 5 mm is associated with improved local control and prolonged survival. Nonetheless, margins that are close (1-5 mm) or positive (less than 1 mm) are often observed in practice, especially for the deep margins. Ultrasound is a promising tool for assessing the depth of invasion, providing non-invasive, real-time imaging for accurate evaluation. We conducted a clinical trial using a novel portable 3D ultrasound imaging technique to assess ex vivo surgical margin assessment in the operating room. During the operation, resected surgical specimens underwent 3D ultrasound scanning. Four head and neck surgeons measured the surgical margins (deep, medial, and lateral) and tumor area on the 3D ultrasound volume. These results were then compared with the histopathology findings evaluated by two head and neck pathologists. Six patients diagnosed with tongue SCC (three T1 stage and three T2 stage) were enrolled for a consecutive cohort. The margin status was correctly categorized as free by 3D ultrasound in five cases, and one case with a "free" margin status was incorrectly categorized by 3D ultrasound as a "close" margin. The Pearson correlation between ultrasound and histopathology was 0.7 (p < 0.001), 0.6 (p < 0.001), and 0.3 (p < 0.05) for deep, medial, and lateral margin measurements, respectively. Bland-Altman analysis compared the mean difference and 95% limits of agreement (LOA) for deep margin measurement by 3D ultrasound and histopathology, with a mean difference of 0.7 mm (SD 1.15 mm). This clinical trial found that 3D ultrasound is accurate in deep margin measurements. The implementation of intraoperative 3D ultrasound imaging of surgical specimens may improve the number of free margins after tongue cancer treatment.

The Depth of Invasion and Level IV Cervical Node Metastasis in Patients with Clinically N0 Tongue Cancer.

The accurate indication for level IV dissection is crucial for preventing complications such as phrenic nerve damage and chylous fistulas in clinically N0 tongue cancer. Although the depth of invasion is an established independent risk factor for occult lymph node metastasis in tongue cancer, its relationship with level IV metastasis has not been evaluated. This study investigated the relationship between the depth of invasion and level IV nodal metastasis in clinically N0 tongue cancer. We retrospectively investigated clinical N0 patients who underwent glossectomy and level I-IV neck dissection. We examined lymph node metastasis, risk factors, and the relationship between depth of invasion and metastasis. Our study included 58 patients, and no patient had isolated level IV metastasis. Additionally, there was no level IV metastasis in well-differentiated tumors. Tumor size, depth of invasion, differentiation, and perineural invasion were significantly associated with level IV neck metastasis. We found a critical tumor size of 2.5cm and depth of invasion of 8mm for level IV neck metastasis. Based on our findings, we recommend that level IV dissection should be considered for poorly differentiated tumors, tumors greater than 2.5cm in size, and those deeper than 8mm. This study highlights the importance of depth of invasion as a prognostic factor for predicting level IV metastasis and suggests that our findings can be used to prevent unnecessary level IV dissections that may lead to complications in tongue cancer surgery.

Correlation during the extent of surgical resection, oral function and quality of life after tongue cancer surgery: Single-institution study

IntroductionThe extent of surgical resection for tongue tumors is determined by tumor size, potentially affecting oral function and quality of life (QoL). However, the relationship between oral dysfunction and QoL decline due to glossectomy extent remains unexplored. Therefore, these correlations and their predictive value for postoperative QoL decline were elucidated. MethodsPatients treated for tongue cancer at our hospital between 2018 and 2022 were categorized by partial, hemi, or subtotal/total glossectomy. Assessments included swallowing function (RSST), articulation (Oral Diadochokinesis (ODK)), mastication, tongue pressure, and oral moisture. QoL was measured using the Oral Health Impact Profile-14 (OHIP-14). Differences within parameters were assessed using Kruskal–Wallis tests, and between-group comparisons via Mann–Whitney U tests. Spearman's correlation analysis examined parameter relationship. Results35 patients were evaluated. Significant differences were found in ODK [ta] (p = 0.015), [ka] (p = 0.0006), tongue pressure (p = 0.0001), moisture levels (p = 0.031), OHIP-14 domains: physical disability (p = 0.014) and social disability (p = 0.046). ODK [ta] (PG: 5.95, HG: 5.38, TG: 4.03 times), [ka] (PG: 5.56, HG: 4.78, TG: 3.23 times), and tongue pressure (PG: 32.9, HG: 21.2, TG: 10.3 mmHg) decreased with glossectomy extent, while physical (PG: 0.27, HG: 2.38, TG: 2.00) and social disability (PG: 0.18, HG: 0.94, TG: 1.43) worsened. A significant negative correlation was observed between tongue pressure and social disability (p = 0.013, r = -0.36). ConclusionExpanding resection significantly impacted postoperative oral function and QoL. Tongue pressure assessment may predict long-term social disability in patient QoL.

Research progress in functional regeneration methods and mechanisms of taste buds

Gustation is one of the most important human senses. Taste dysfunctions, which may be due to aging, tongue cancer surgery, radiotherapy and chemotherapy, affect life quality. That is why the need for taste bud regeneration has received more attention. At present, research on development and renewal of taste cells provides a basis for taste bud regeneration; molecular mechanisms related to taste bud regeneration are being continuously uncoverd, aiding in the identification of more accurate targets for therapy. New methods such as nerve regeneration, tissue engineering, and cytokine therapy have emerged. The author reviews the mechanism and the latest methods of taste bud regeneration of lingual epithelium, aiming to open new horizions for the prevention and treatment of gustatory diseases, and provide theoretical references for its regeneration.

Modified submandibular mandibulotomy approach versus lip-splitting approach in tongue cancer surgery: a retrospective paired-cohort study.

The surgical approach for resection and reconstruction of tongue cancer (TSCC) with or without the lip-splitting incision is controversial. This study introduced a modified approach without lip-splitting and the clinical results were assessed. Sixty-eight TSCC patients underwent surgery using the modified submandibular mandibulotomy (MSMM) approach without lip-splitting, and another matched 68 patients using lip-splitting mandibulotomy (LSM) approach were enrolled in this study. The clinical results including intraoperative relevance and surgical morbidities, survival status, facial appearance and scar scores, function of lower lip, and quality of life (QOL) were evaluated. The primary tumors were en bloc resected through the MSMM approach with excellent tumor exposure and R0 resection margins as LSM approach. The survival status and complications were similar in both groups. The function of lower lip was better in patients of MSMM group at 1month after surgery. The MSMM approach was associated with significantly better facial appearance and recreation compared to LSM approach by scar scores and QOL assessment. The MSMM approach without lip-splitting achieves similar tumor control, better aesthetic results, and QOL compared to LSM approach. It is a safe and effective surgical approach for patients with TSCC. The MSMM approach without lip-splitting is oncological safety in tongue cancer surgery and is scrutinized as one part of the treatment concept for better aesthetic results.

3D Ultrasound and MRI in Assessing Resection Margins during Tongue Cancer Surgery: A Research Protocol for a Clinical Diagnostic Accuracy Study.

Surgery is the primary treatment for tongue cancer. The goal is a complete resection of the tumor with an adequate margin of healthy tissue around the tumor.Inadequate margins lead to a high risk of local cancer recurrence and the need for adjuvant therapies. Ex vivo imaging of the resected surgical specimen has been suggested for margin assessment and improved surgical results. Therefore, we have developed a novel three-dimensional (3D) ultrasound imaging technique to improve the assessment of resection margins during surgery. In this research protocol, we describe a study comparing the accuracy of 3D ultrasound, magnetic resonance imaging (MRI), and clinical examination of the surgical specimen to assess the resection margins during cancer surgery. Tumor segmentation and margin measurement will be performed using 3D ultrasound and MRI of the ex vivo specimen. We will determine the accuracy of each method by comparing the margin measurements and the proportion of correctly classified margins (positive, close, and free) obtained by each technique with respect to the gold standard histopathology.

Neoadjuvant use of oncolytic herpes virus G47Δ prevents local recurrence after insufficient resection in tongue cancer models

A complete resection of tongue cancer is often difficult. We investigate the usefulness of administering G47Δ (teserpaturev), a triple-mutated oncolytic herpes simplex virus type 1, prior to resection. G47Δ exhibits good cytopathic effects and replication capabilities in all head and neck cancer cell lines tested. In an orthotopic SCCVII tongue cancer model of C3H/He mice, an intratumoral inoculation with G47Δ significantly prolongs the survival. Further, mice with orthotopic tongue cancer received neoadjuvant G47Δ (or mock) therapy with or without "hemilateral" resection, the maximum extent avoiding surgical deaths. Neoadjuvant G47Δ and resection led to 10/10 survival (120days), whereas the survivals for G47Δ alone and resection alone were 6/10 and 5/10, respectively: all control animals died by day 11. Furthermore, 100% survival was achieved with neoadjuvant G47Δ therapy even when the resection area was narrowed to "partial," providing insufficient resection margins, whereas hemilateral resection alone caused death by local recurrence in half of the animals. G47Δ therapy caused increased number of tumor-infiltrating CD8+ and CD4+ cells, increased F4/80+ cells within the residual tongues, and increased expression of immune-related genes in and around the tumor. These results imply that neoadjuvant use of G47Δ is useful for preventing local recurrence after tongue cancer surgery.

Effect of Goal-directed Fluid Therapy on Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Combined Lingual and Cervical Radical Surgery

Background: The intraoperative rehydration technique known as the effect of Goal-Directed Fluid Therapy (GDFT), which is guided by the dynamic monitoring of volume responsiveness, has received a lot of attention recently. According to a meta-analysis by Bene, GDFT can maintain intraoperative hemodynamic stability, which lowers the incidence of postoperative complications and reduces stay at the intensive care unit. Objectives: This study aimed to determine how GDFT affected elderly patients who underwent combined lingual and cervical radical surgery after an operation for postoperative cognitive dysfunction (POCD). Methods: This interventional study was conducted between December 2021 and December 2022 in a medical center affiliated with Fujian Medical University on people undergoing radical neck and tongue surgery for tongue cancer. The samples (n=36) were selected using an availability sampling method and randomly divided into conventional fluid therapy (the Non-GDFT, n=18) and GDFT (n=18) groups. The Non-GDFT group was hydrated normally during anesthesia. A continuous infusion of 8 mL/(kg/h) of compounded sodium chloride was administered to the GDFT group to maintain basal hydration volume during the operation. Before and following surgery, Montreal Cognitive Assessment Scale scores were completed, arterial blood lactate values and bilateral cerebral oxygen saturation levels were measured at various times following the stabilization of anesthesia, and the levels of interleukin 6 (IL-6) and S100 protein in venous blood were calculated. Results: The Non-GDFT group had a higher incidence of POCD than the GDFT group, the GDFT group had significantly lower levels of IL-6 and S100 than the Non-GDFT group, the GDFT group had significantly lower levels of serum lactate than the Non-GDFT group. The GDFT group experienced significantly lower rates of intraoperative hypotensive and intraoperative low rSO2 events than the Non-GDFT group, and this difference was statistically significant (P&lt;0.05). Conclusion: Assuring the balance of cerebral oxygen supply and demand, lowering the production of inflammatory mediators, and successfully reducing the incidence of POCD are all possible benefits of GDFT.

Twelve Years of Establishing the Strategies for Tongue Reconstruction.

Reconstruction after resection of malignant tongue tumors remains one of the most difficult problems in head and neck oncology. Recent trends in tongue reconstruction have focused on optimizing speech and swallowing functions and maximizing quality of life. In the recent literature, several reconstructive strategies including regional flaps and free flaps have been described. A case series of 328 patients underwent oral tongue reconstruction between March 2011 and March 2022. Functional evaluation was performed in all patients 3 months after reconstruction (where the patients required no adjuvant radiotherapy) or after radiotherapy. Total flap necrosis was seen in 5 patients with free flap reconstruction (2 radial forearm flaps, 1 lateral arm flap, and 2 anterolateral thigh flaps), 5 patients with infrahyoid myocutaneous flap, and 1 patient reconstructed with a supraclavicular flap. Our success rate is 96.6%; partial flap necrosis was observed in 11 patients with infrahyoid myocutaneous flap and 2 patients with a supraclavicular flap. Most patients with subtotal glossectomy or smaller defects (type II-IVA defects) could communicate on the phone and had the near-normal capacity for an oral diet. The remaining patients (type IVB-V defects) had significantly lower speech scores. The majority of patients could eat liquid and semiliquid foods. Tongue cancer surgery and subsequent reconstruction posed exciting challenges for the surgeon to optimize tongue function and quality of life for patients. Attention to the principles of tongue reconstruction and choosing appropriate flap for each defect achieve better functional results.

The function of the tongue of morphology and function after surgery and tongue reconstruction evaluation analysis

The tongue body is with special physiological functions of organs, function recovery after the defect is the major problem of the oral and maxillofacial surgery. At present, the tongue. Over the years, scholars have been committed to studying a variety of tongue reconstruction methods based on anatomical and functional repair. With the continuous introduction of the concept of functional surgery, the goal of tongue defect reconstruction after tongue cancer surgery has been raised from physical recovery to equal attention to function and appearance, and various tissue flap repair technologies have been widely used in clinical practice and mature, so it has become possible to reshape the original shape of patients' tongue.

Alterations of posterior pharyngeal wall movement during swallowing in postoperative tongue cancer patients: assessment with a videofluoroscopic swallowing study.

This study aimed to determine the association between the progressive contraction of the posterior pharyngeal wall and dysphagia in postoperative patients with tongue cancer. A videofluoroscopic swallowing study (VFSS) was performed in 34 patients after tongue cancer surgery. Images were analyzed using a two-dimensional video measurement software. Cases in which the processes on the posterior pharyngeal wall moved downward from the 2nd to 4th vertebral regions were defined as "normal type", other cases were defined as "abnormal type". Twenty-four patients showed normal movement of the posterior pharyngeal wall, whereas 10 patients showed the abnormal type. The results showed that there was a significant difference in dysphagia scores between the postoperative swallowing type and swallowing dysfunction score. This implies that dysphagia is related to the movement of the posterior pharyngeal wall after tongue cancer surgery. Furthermore, the extent of resection and stage were significantly different between the normal and abnormal groups in the posterior pharyngeal wall movement. There was also a significant difference between the two groups in terms of the following: whether the tongue base was included in the excision range (p < 0.01), whether neck dissection was performed (p < 0.01), or whether reconstruction was not performed (p < 0.01). VFSS results showed that posterior pharyngeal wall movement was altered after surgery in patients with tongue cancer who had severe dysphagia.

Expert consensus on surgical treatment of tongue squamous cell carcinoma

The annual incidence of oral cancer in the world is more than 300 000, and the five-year survival rate is 50%~60%. Every year, 145 400 people died due to tongue cancer, of which tongue cancer accounts for nearly 40%. Although tongue cancer has tumor heterogeneity and individual differences in prognosis, surgery is still the first choice for the treatment of tongue cancer. The effect of tongue cancer surgery can directly determine the survival time of patients. The defect caused by tongue cancer surgery seriously affects the patients' physical functions such as appearance, language, chewing and swallowing. The surgical treatment of tongue cancer with functional reconstruction can improve the quality of life of patients. In the past few decades, genomics has enhanced understanding of tongue cancer. The preclinical tumor model preserves the tumor heterogeneity, which has a great application prospect in the discovery of tumor biomarkers and the clinical translation of drugs. Many advances have been made in the diagnosis and treatment of tongue cancer, but there are still many controversies in clinical practice. Therefore, this expert consensus summarizes the progress and controversial hot spots of surgical diagnosis and treatment of tongue cancer, mainly including preoperative diagnosis and evaluation, surgical treatment points and postoperative functional rehabilitation.

Combination of fluorescence visualization and iodine solution-guided surgery for local control of early tongue cancer

The control of enclosed oral epithelial dysplasia is important for the control of oral cancer. Fluorescence visualization and iodine solution are able to detect oral epithelial dysplasia and surrounding oral cancer. The purpose of this study was to clarify the effectiveness of combining fluorescence visualization and iodine solution-guided surgery for early tongue cancer. Participants comprised 264 patients with primary early tongue cancer who underwent surgery. The surgical margin was set at 10 mm outside the clinical tumour, and 5 mm outside the area of fluorescence visualization loss, and 5mm outside the iodine unstained area. The 5-year disease-free survival rate was 87.1% vs 76.1% (P = 0.016) and the 5-year local control rate was 98.6% vs 93.0% (P = 0.008) for combination-guided surgery when compared to conventional surgery. Positive margin rates were 0% for cancer, and 6.5% and 0% for low- and high-grade dysplasia, respectively, with combination-guided surgery (P = 0.257). Multivariate analysis revealed that combination-guided surgery (odds ratio 0.140, 95% confidence interval 0.045–0.437; P < 0.001) and intraoperative frozen section examination (odds ratio 0.302; 95% confidence interval 0.115–0.791; P = 0.015) were significantly associated with local control. The combination of fluorescence visualization and iodine solution are effective in selecting surgical margins for early tongue cancer.

Aspiration Patterns Observed in Patients With Free Flap Reconstruction Following T3 and T4 Tongue and Oropharyngeal Cancer Surgery: A Fiberoptic Endoscopic Evaluation of Swallowing

Background and Objectives The objectives of this study were to investigate the aspiration patterns in patients with T3 and T4 oral and oropharyngeal cancers after free flap reconstruction following primary tumor resection and determine the effect of tongue base resection on aspiration patterns in these patients.Subjects and Method The aspiration pattern was evaluated via fiberoptic endoscopic evaluation of swallowing and classified into three groups based on the timing of aspiration in relation to the swallowing process. More than two types of aspiration patterns observed simultaneously in a patient suggested combined aspiration pattern.Results The major pattern of aspiration in 31 patients with oral cavity cancer was aspiration after swallowing in the group with base of tongue (BOT) preserved (83.3%, 10/12) and combined aspiration in the group with BOT resection (63.2%, 12/19), showing a significant difference in aspiration pattern between the two groups (p&lt;0.001). In oropharyngeal malignancies, the major pattern of aspiration was aspiration after swallowing in both BOT-preserving (87.5%, 21/24) and BOT-resecting groups (75.0%, 9/12), showing a significant difference in aspiration pattern between the two groups (p=0.031).Conclusion The most common pattern observed in the advanced T stage tongue cancer patients after glossectomy was aspiration after swallowing. Resection of BOT greater than 25% in the tongue and oropharyngeal cancer was a significant factor causing the combined type of aspiration.

Application of an L-shaped anterolateral thigh flap in reconstruction after hemiglossectomy

ObjectiveTongue defect reconstruction is one of the key components of tongue cancer surgery. In this study, we used an L-shaped flap design adopted as a simple and efficient method to repair tongue defects after hemiglossectomy. Furthermore, we evaluated and contrasted the clinical effects of two methods, the L-shaped and traditional methods.Study designFifteen patients in the L-shaped group and 20 patients in the traditional group were evaluated and compared in terms of postoperative complications, dysphagia, language function and appearance satisfaction.ResultsThe results (Table 1) showed that there were 2 cases of donor area invalid traumas, and 2 patients had scar hyperplasia in the traditional group. The degree of global and functional dysphagia of the L-shaped group (2.60 ± 0.29 and 11.47 ± 1.38) was lower than that of the traditional group (3.55 ± 0.29 and 15.75 ± 1.22) (P < 0.05). In the language evaluation, the traditional group (3.20 ± 0.26) had lower scores than the L-shaped group (4.13 ± 0.30) (P < 0.05).ConclusionThe L-shaped ALTP flap is a simple and efficient modification of ALTP, that can be used for half-tongue repair after radical operations for tongue cancer. It has better performance in the recovery of dysphagia and language function than the traditional ALTP flap.

Feasibility of pectoralis major myocutaneous flap for primary reconstruction of near-total glossectomy defects: A report of 2 cases

The aim of tongue cancer surgery is to restore speech and swallowing. Smaller defects have a plethora of options, including local and distant flaps to restore volume and function may not be compromised. Large tumours of the tongue require extensive resection - near total or total glossectomy, which creates large volume defects. Free flaps using microvascular reconstruction techniques are the ideal method of reconstruction in such defects. Regional flaps like pectoralis major myocutaneous (PMMC) flaps are used only as salvage flaps when the free flaps fail and they are not used as the primary method of reconstruction. The disadvantage with free flaps is that it requires a team of surgeons with microvascular expertise, which may not be feasible in low-resource settings. Hence, the workhorse flap of head–neck reconstruction, the PMMC flap, has a lot to offer in the primary reconstruction of large tongue defects. There is always a risk of lifelong dependence on feeding tubes and tracheostomy tubes following these surgeries despite free flap reconstruction. The outcomes of the reconstruction methods are validated by the absence of dependence on these tubes. We report 2 cases of near glossectomy defects reconstructed primarily by PMMC flap and the functional outcomes of speech and swallowing and the absence of dependence on tubes for feeding and breathing.

Speech outcome in tongue cancer surgery: objective evaluation by acoustic analysis software

AbstractBACKGROUND.Cancer of the oral cavity is one of the most common malignancies of which 60% affect the tongue. Carcinoma of the tongue causes significant alterations of the articulatory and swallowing functions. The gold standard of care remains primary surgical resection with or without postoperative adjuvant therapy. Whereas T1 and T2 tongue tumors can be treated with more conservative surgeries, as partial glossectomies, the larger tumors require total and aggressive glossectomies which increase survival, but, on the other hand, they might often make speech, chewing and swallowing impossible.MATERIAL AND METHODS.Our study was performed on a total of 21 patients with Squamous Cell Carcinoma of the tongue who underwent either partial resection or hemiglossectomy. Each subject (either surgical patients or controls) was asked to pronounce the vowels /a/, /e/, /i/, /u/, and all signals were evaluated separately by two operators. Acoustic (F0, jitter, shimmer, NHR) and vowel metric (the ratio F2i/F2u, tVSA, qVSA, FCR) features have been extracted. In order to define the speech intelligibility, all patients were evaluated by two doctors and one speech therapist and all patients received the Speech Handicap Index (SHI) translated into Italian language before recording.RESULTS.No statistically significant variations were observed, regardless of the gender, between controls and surgically resected patients when tumor staging was T1-T2. On the contrary, when patients had to undergo more extensive surgical resection due to the presence of a T3-T4 tumor, a dramatic increase of F2u could be observed. This change, together with a decrease of F2i, led to a highly significant reduction in the F2i/F2u parameter in surgically resected patients as compared to controls. The other parameters which were reduced in a statistically significant manner in T3-T4 surgically resected patients were tVSA and qVSA. Instead, two parameters increased in a statistically significant manner in T3-T4 surgically resected patients: FCR and SHI. Again, none of the above-mentioned parameters was altered in a statistically significant manner in early tumor stage resected patients, regardless of the gender.CONCLUSION.For the first time, we used a series of newly developed formant parameters, introduced by various authors for the study of the articulatory undershoot of the tongue in various neurodegenerative diseases. The statistical analysis of our results highlighted in an incontrovertible way a strong correlation and significance of each of our parameters F2 / i / / F2 / u /, FCR, tVSA, qVSA, with the entity of the TNM, and therefore of the surgical extension of the resection, and in parallel with the loss of the intelligibility of the speech that proportionally reaches higher values in the advanced stages of the disease as can be deduced from the SHI trend.

RF Coil Setup for 31P MRSI in Tongue Cancer in vivo at 7 T.

Surgery for tongue cancer often results in a major loss in quality of life. While MRI may be used to minimise the volume of excised tissue, often the full tumour extent is missed. This tumour extent may be detected with metabolic imaging. One of the main reasons for the lack of metabolic information on tongue cancer would be the absence of an x-nuclear coil with the tongue as a focus target. Metabolic MRI through 31P MRSI is known as a powerful tool to non-invasively study elevated cell proliferation and disturbed energy metabolism in tumours. Severe magnetic field non-uniformities are inherently caused by the substantial difference in magnetic susceptibilities of tissue and air in the mouth and its environs. Despite this, the wide chemical shift dispersion of 31P could still facilitate precise detection of the cell proliferation biomarkers, phospomonoesters and diesters, as well as energy metabolites ATP, inorganic phosphate, and phosphocreatine potentially mapped over the tongue or tumour in vivo. In this study, we present the first 31P MRSI data of the human tongue in vivo from healthy volunteers and a patient with a tongue tumour at 7 T MRI using a 1H 8-channel transceiver setup placed inside a body 31P transmitter, which is able to get a uniform excitation from the tongue while providing comfortable access to the patient. In addition, a user-friendly external 31P receiver array is used to provide high sensitivity (80%) comparable to an uncomfortable inner mouth loop coil positioned on the tongue. The primary aim is the demonstration of 31P metabolite profiles in the tongue and the differences between healthy and malignant tissue. Indeed, clear elevated cell proliferation expressed as enhanced phosphomonoesters is observed in the tumour vs. the healthy part of the tongue. This can be performed within a total scan duration of 30 min, comparable to clinical scans, with a spatial resolution of 1.5 cm for the 10-min 31P MRSI scan.

Midline versus paramedian mandibulotomy for tongue cancer surgery: analysis of complications

Midline and paramedian mandibulotomies both have distinct anatomical and surgical strengths. A retrospective study was performed at Chang Gung Memorial Hospital, Linkou Branch between 2014 and 2019 to investigate how the osteotomy site (midline (n = 221) or paramedian (n = 44)) and type (straight, notched, or stair-stepped) affect postoperative and post-radiotherapy complications in patients undergoing wide excision of tongue cancer with flap reconstruction. Midline mandibulotomies were predominantly of the straight osteotomy type, while paramedian mandibulotomies were mostly notched type (P < 0.001). Comparably low elective tooth extraction rates were found in both approaches (P = 0.556). Paramedian mandibulotomy showed a higher osteoradionecrosis rate (P = 0.026), but there was no significance in the sub-analysis of individual types. Paramedian sites were associated with more early infection (P = 0.036) and plate exposure (P = 0.036) than midline sites with the straight osteotomy type, but complication rates did not differ significantly for the notched and stair-stepped types. Paramedian sites (P = 0.020) and notched types (P = 0.006) were associated with higher odds of osteoradionecrosis in the univariable logistic regression analysis, but only the notched type remained significant in the multivariable analysis (P = 0.048). In conclusion, paramedian sites increased the rate of osteoradionecrosis, and correlation with the osteotomy type resulted in more osteoradionecrosis in notched types and more complications in straight paramedian mandibulotomies.