Oral Cavity Tumors Research Articles

Improving of classification accuracy of cyst and tumor using local polynomial estimator

Cyst and tumor in oral cavity are seriously noticed by health experts along with increasing death cases of oral cancer in developing country. Early detection of cyst and tumor using dental panoramic image is needed since its initial growth does not cause any complaints. Image processing is done by mean for distinguishing the classification of cyst and tumor. The results in previous studies about classification of cyst and tumor were done by using a mathematical computation approach namely supports vector machine method that have still not satisfied and have not been validated. Therefore, in this study we propose a method, i.e., nonparametric regression model based on local polynomial estimator that can be improve the classification accuracy of cyst and tumor on human dental panoramic image. By using the proposed method, we get the classification accuracy of cyst and tumor, i.e., 90.91% which is greater than those by using the support vector machine method, i.e., 76.67%. Also, in validation process we obtain that the nonparametric regression model approach gives a significant Press’s Q statistical testing value. So, we conclude that the nonparametric regression model approach improves the classification accuracy and gives better outcome to classify cyst and tumor using dental panoramic image than the support vector machine method.

Association of Glutathione-S-Transferases M1 and T1 Deletional Variants with Development of Oral Squamous Cell Carcinoma: A Study in the South-East of Iran.

Background:The role of genetic polymorphisms in genes of Glutathione-S-transferases (GST) enzymes in susceptibility to oral cavity cancers is controversial. Oral Squamous Cell Carcinoma (OSCC) is the most common oral cavity neoplasm. Aimed to evaluate the potential impacts of two well-known null variants residing in the gene encoding GSTM1 and GSTT1 enzymes of OSCC patients in the southeast of Iran. Methods:In a case-control design, 113 individuals (50 OSCC patients, and 63 healthy subjects) were included. DNA was extracted using paraffin-embedded tissues. GST genotyping was carried out using multiplex PCR. Results:In 113 participants, 41 (36.3%) and 72 (63.7%) were males and females respectively. No significant difference was recognized for distribution of GSTM1 (P=0.11) and GSTT1 (P=0.28) null genotypes between OSCC patients (58%, and 24% respectively) and healthy controls (42.9% and 15.9% respectively). Also, no significant difference was noted regarding the frequency of GSTM1 null genotype in different histological grades, however, those patients with more aggressive disease (poorly differentiated or grade III) revealed with a significantly higher ratio (66.7%) of GSTT1 null genotype (P=0.002). The highest odds ratio for OSCC was related to combined null genotypes for GSTM1 and GSTT1 (OR=2.5, 95% CI: 0.7-9.2), however, this was not statistically significant finding (P=0.15). Conclusion:Null genotypes polymorphisms were more common in OSCC than healthy individuals. GSTT1 null genotype may be an important genetic factor in the progression of OSCC.

Disruption of TP63-miR-27a* Feedback Loop by Mutant TP53 in Head and Neck Cancer.

Alterations in the epidermal growth factor receptor and PI3K pathways in head and neck squamous cell carcinomas (HNSCCs) are frequent events that promote tumor progression. Ectopic expression of the epidermal growth factor receptor-targeting microRNA (miR), miR-27a* (miR-27a-5p), inhibits tumor growth. We sought to identify mechanisms mediating repression of miR-27a* in HNSCC, which have not been previously identified. We quantified miR-27a* in 47 oral cavity squamous cell carcinoma patient samples along with analysis of miR-27a* in 73 oropharyngeal and 66 human papillomavirus-positive (HPV+) samples from The Cancer Genome Atlas. In vivo and in vitro TP53 models engineered to express mutant TP53, along with promoter analysis using chromatin immunoprecipitation and luciferase assays, were used to identify the role of TP53 and TP63 in miR-27a* transcription. An HNSCC cell line engineered to conditionally express miR-27a* was used in vitro to determine effects of miR-27a* on target genes and tumor cells. miR-27a* expression was repressed in 47 oral cavity tumor samples vs matched normal tissue (mean log2 difference = -0.023, 95% confidence interval = -0.044 to -0.002; two-sided paired t test, P = .03), and low miR-27a* levels were associated with poor survival in HPV+ and oropharyngeal HNSCC samples. Binding of ΔNp63α to the promoter led to an upregulation of miR-27a*. In vitro and in vivo findings showed that mutant TP53 represses the miR-27a* promoter, downregulating miR-27a* levels. ΔNp63α and nucleoporin 62, a protein involved in ΔNP63α transport, were validated as novel targets of miR-27a*. Our results characterize a negative feedback loop between TP63 and miR-27a*. Genetic alterations in TP53, a frequent event in HNSCC, disrupt this regulatory loop by repressing miR-27a* expression, promoting tumor survival.

Fibular free flap in mandible reconstruction, a long-term follow-up.

Fibula free-flap mandible reconstruction is the gold standard in mandibulectomized patients due to bone or oral cavity tumors. Long term follow-up and complications of this procedure are barely reported. To know long term outcomes of patients with fibula free-flap. Clinical evaluation of patients with fibula free-flap mandible reconstruction, 10 years after procedure. Patients intervened from 1996 to 2006 were included, clinically assessing: oral functionality, habitual dietary intake, complications and aesthetic satisfaction. 87 patients were included; 70 of them with bone tumors and 17 with oral carcinomas. Were successful 73 flaps, and 14 got total or partial loss, so, they were excluded. In all cases dietary regimen was similar to their original one before resection; even when in average, 3 years were necessary to get this normal intake. Any of them required major re-operation during the follow-up period and there was no late loss of the flap either. Functionality was considered normal in 100% of the cases and 80% considered themselves as aesthetically satisfied. Fibula free-flap offers a secure alternative for long term mandibular reconstruction.

A Nationwide analysis of mortality trends in geriatric and non-geriatric patients with oral cavity tumors.

e17510 Background: Squamous cell carcinoma is the most common histological-subtype of oral cavity tumors and no major advances in its treatment have occurred recently. However, p16 positive tumors have been noted to have a better prognosis than p16 negative tumors. Older patients have increasingly been found to have p16 positive oral cavity cancers. This study explores the incidence based mortality of geriatric patients irrespective of p16 status. Methods: Data from Surveillance, Epidemiology, and End Results (SEER) Database was extracted to study the incidence-based mortality for the years 2000 to 2014. Incidence-based mortality for all stages of oral cavity tumors was queried and the results were grouped by age (geriatric vs. non-geriatric) and race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander). All stages and both genders were included in the analysis. T-test was used to determine statistically significant difference between various subgroups. Linear trend lines were used to visualize the mortality trends between various subgroups (Geriatric vs. Non- geriatric and Caucasian vs. African American). Results: Incidence-based mortality for oral cavity tumors has worsened since 2000 to 2014 for geriatric patients (p < 0.05) when compared to non-geriatric patients in both Caucasian/White patients and African American/Black patients. The results are summarized in the table below. Conclusions: The similarity in incidence-based mortality for geriatric patients with oral cavity tumors is high in all races and may imply age as a significant risk factor in these patients. A stage-specific, gender-specific and age-binned analysis may help differentiate these concerning trends. [Table: see text]

A new CT dynamic maneuver “Mouth Opened with Tongue Extended” can improve the clinical TNM staging of oral cavity and oropharynx squamous cell carcinomas

ObjectivesCross sectional imaging is mandatory for oral cavity and oropharynx head and neck squamous cell carcinoma's (ooSCC) local extension and TNM staging. However a complex anatomy and frequent dental metallic artifacts make it difficult. This study assesses the clinical benefit of “Mouth Open with Tongue Extended” dynamic maneuver at CT (CTmote) as compared to the conventional CT (CTconv) and MRI. MaterialRetrospectively, 58 patients with histologically proven ooSCC (oral cavity: 34; oropharynx: 24) were included in the study. All had endoscopy with biopsies, MRI, CTconv and an CTmote acquisitions. Data were splitted in 3 datasets and 2 independent radiologists performed readings blindly. Gold standard was pTNM in 31% of cases; otherwise cTNM obtained at multidisciplinary team meeting with endoscopy and mapping biopsies were used. ResultsCTmote was feasible for all patients including those already treated by surgery or radiotherapy. Exact TNM staging was obtained in 68%, 83%, 83% for CTconv, CTmote and MRI respectively. The best exam ratings at paired wise comparisons were 3%, 47%, 50% for CTconv, CTmote and MRI respectively. CTmote and MRI observer agreements, image quality and confidence ratings, were comparable and higher compared to CTconv (p < 0.001). ConclusionsCTmote improves oral cavity and oropharynx tumour stage assessment compared to CTconv with performances close to those of MRI examination. In clinical practice, combining both CT with MOTE maneuver and MRI seems to be the optimal imaging strategy for local staging.

Quality of life after mandibulectomy: the impact of the resected subsite

The purpose of this study was to identify the factors that impact the quality of life (QOL) scores of patients undergoing mandibulectomy.All patients with a diagnosis of an oral cavity neoplasm involving the mandible who underwent a mandibulectomy between January 1, 2000 and December 31, 2015 and completed a University of Washington QOL questionnaire (UW-QOL) were included in the study.Fifty-eight patients fulfilled all inclusion criteria and completed the UW-QOL questionnaire. Forty patients (69%) underwent a segmental mandibulectomy and 18 patients underwent a marginal mandibulectomy. Forty-eight patients (82.7%) had a free flap reconstruction. There was no significant difference in the QOL scores between patients who underwent a marginal or a segmental mandibulectomy. In contrast, patients who underwent symphysial resection reported significantly worse scores in various domains compared to patients with body or ramus segmental mandibulectomy.Patients who underwent a segmental mandibulectomy that included the symphysis had worse outcomes in chewing, recreation, health-related and social QOL domains compared to those whose mandibulectomy did not include the symphysis.

Human papillomavirus DNA detection, p16INK4a, and oral cavity cancer in a U.S. population

ObjectivesThe role of HPV in oral cavity cancers was investigated using two markers of viral exposure. Materials and methodsHPV DNA and p16INK4a expression were evaluated in tumor tissue from a U.S. population-based sample of 122 invasive oral cavity cancer cases. ResultsHPV DNA was detected in 38 of 122 (31%) oral cavity tumors. Seven genotypes were detected including HPV 16, which was found in 22% of tumors. p16INK4a was expressed in 30% of tumors and was poorly correlated with HPV DNA detection (Kappa <0.1). Joint positivity for HPV 16 and/or 18 and p16INK4a was observed in only 7% of cases. When comparing cases diagnosed in 1993–1999 and in 2000–2004, positivity for HPV DNA 16/18 increased from 19% to 39% (p = 0.02) and joint HPV 16/18 – p16INK4a positivity increased from 0% to 12% (p = 0.01). For gingival tumors, HPV 16 and/or 18 positivity was 67% compared to 11–38% for other sites (p = 0.02); joint HPV 16/18 – p16INK4a positivity was 33% compared to 0–8% for other sites (p = 0.01). The association of HPV with gingival tumors and more recent diagnosis period remained after adjustment for age and stage (p < 0.05). Neither HPV DNA nor p16INK4a were associated with overall survival. ConclusionsBased on both HPV DNA and p16INK4a, HPV is etiologically linked to a limited subset of oral cavity cancers. However, the role of HPV in oral cavity cancer may vary widely by subsite and may have increased over time, similar to trends observed for oropharyngeal cancer.

Fish/shellfish intake and the risk of head and neck cancer.

Fish intake and other dietary sources of omega-3 fatty acids have been shown to be associated with a reduced risk for some cancers. Although previous studies of head and neck cancer have reported associations with different dietary factors, including reduced risks for fruits and vegetables and putatively healthy dietary patterns, associations specific to fish intake are unclear. This study investigated the association between fish/shellfish intake and risk of squamous cell carcinoma of the head and neck (SCCHN) using data from the Carolina Head and Neck Cancer Epidemiology Study, a population-based case-control study conducted in 46 North Carolina counties with cases recruited from 2002 through 2006. Controls were frequency matched to the cases on age, sex, and race; the final sample size was 1039 cases and 1375 controls. Demographic, lifestyle, and dietary information were collected using an in-person interviewer-administered structured questionnaire. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated with unconditional logistic regression. Patients whose fish/shellfish intake was among the highest tertile had a 20% lower odds of SCCHN compared with those in the lowest tertile (OR: 0.80; 95% CI: 0.60-1.07) after adjustment for the matching and other factors (income, energy intake, fruit intake, cigarette smoking, and alcohol intake). The inverse association was more pronounced for oral cavity and oropharyngeal tumors, for African Americans, and for females, but CIs were wide. To further investigate this potential risk reduction strategy for SCCHN, future studies should consider examining specific fish/shellfish, cooking practices, and other omega-3 fatty acid sources.

Evaluation of Quality of Life After Mandibular Reconstruction Using a Novel Fixed Implant-Supported Dental Prosthesis Concept: A Pilot Study.

To evaluate the feasibility and efficacy of a novel concept of early loaded (ie, within 2 weeks) implant-supported fixed dental prostheses (ISFDP) for patients who underwent mandibular reconstruction. All patients requiring mandibular reconstruction between July 2013 and March 2016 at AZ Sint-Jan Brugge-Oostende AV were screened for dental rehabilitation according to the proposed concept. Of 17 patients, 10 were eligible for inclusion. Clinical and radiologic assessments of implant integration and prosthetic survival were performed at 6, 12, 24, and 36 months. Patient satisfaction was assessed prior to and after prosthetic rehabilitation using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires Core 30 and Head & Neck 35, as well as a visual analog scale. Ten patients received mandibular reconstructive surgery for an oral cavity tumor (n = 6), osteoradionecrosis (n = 3), or medication-related osteonecrosis of the jaw (n = 1). Implants were placed within an average of 6 (2 to 21) months postsurgery in a one-stage procedure. Prosthetic rehabilitation was achieved within 2 weeks in 8 of the 10 patients. Two patients received their ISFDP delayed due to postoperative complications. Implant integration and prosthetic outcome at a maximum of 36 months of follow-up were successful in 7 of the 10 patients. At that time, two patients had passed away, while one patient had the ISFPD removed because of graft necrosis after radiotherapy. Patient satisfaction was high, with significant improvement after dental rehabilitation in comparison to mandibular reconstruction alone. The present concept offers a feasible and fast prosthetic rehabilitation that improves patient quality of life.

RADIOTHERMOMETRIC PERSONALISATION OF CHEMO- AND RADIOTHERAPY FOR PATIENTS WITH ADVANCED (III, IVA AND IVB) STAGES MALIGNANT LESIONS OF ORAL CAVITY, THROAT AND EPIGLOTTIS.

optimization of treatment of patients with advanced malignant lesions of oral cavity, throat and epiglot- tis by means of radiothermic control and personalisation of the induction radio sensitizing polychemotherapy prior to radiotherapy or by applying both methods simultaneously. Study is based on the results of treatment 280 patients with morphologically confirmed cancer of mucosae of oral cavity, throat and epigloittis staged III, IVA and IVB without remote metastases were divided into 6 groups depending on a type of a radiotherapy applied. Each group was divided into a treatment and a control subgroup. A choice of treatment for control subgroups was done on the basis of RECIST 1.1. scale; a deci- sion for treatment subgroups was done based on obtained radiothermic (RTM) personalisation data in tumours or metastases.The treatment program included follow-ups according to established guidelines, radiothermic measure- ments, immunology investigations , statistical analysis (cumulative survival by Kaplan-Meier). Groups of patients with tumours of oral cavity and epigloittis with intra-arterial polychemotherapy (IA PCT) prior to radiotherapy demonstrated improved mean 3 years survival rate. Groups with malignant tumours of upper laryngeal tract demonstrated opposite results. A comparison of mean survival rates between groups that were treated with systemic radiochemotherapy but using different combinations of different chemotherapy agents has shown that a use of polyplatilen is superior to combinations with cisplatin. A further study showed that all treat- ment groups had demonstrated better survival rates compared to control groups. The obtained results allow us to conclude that the therapy personalisation based on radiothermic per- sonalisation significantly improves quality and outcomes for patients with localized cancer of oral cavity, throat and epiglottis. RTP can be used as a treatment control method of above mentioned lesions together with standard treat- ment pathways. The application of intra-arterial polychemotheray followed by a radiotherapy of tumours of oral cavity and throat shows better outcomes compared to standard treatments only. The use of induction poly- chemotherapy with polyplatilene for patients with tumours of epiglottis is superior to intra-arterial polychemother- apy and a chemotherapy with cisplatin.

Induction chemotherapy with cisplatin plus weekly paclitaxel followed by chemoradiotherapy for locally advanced squamous cell carcinoma of the head and neck

ABSTRACTThe paclitaxel-cisplatin is a non-infusional alternative for induction chemotherapy (IC) for LASCCHN based on phase-II trials. Here, we describe our institutional experience with this combination in Southern Brazil. Methods: Thirty-three consecutive patients with unresectable LASCCHN were selected between April/2012 and June/2014. They received weekly paclitaxel 80mg/m2 on days 1, 8, 15 and cisplatin 75mg/m2 on day 1 for three cycles followed by chemoradiotherapy (CRT) with cisplatin at standard dose. Overall response, toxicity, progression free survival (PFS) and overall survival (OS) were evaluated. Results: The median follow-up was 25.5 months. Median age was 58.6 years and 96% had PS 1. Most patients presented with bulky disease at stages IVA and IVB (60.6% and 21.2%, respectively). Concerning primary site of tumor, 33.3% were oropharingeal tumors, 27.3% larynx tumors and 33.3% oral cavity tumors. The majority of patients had both smoking and alcohol abuse records. Twenty-eight patients (84.8%) at the time of diagnosis had a BMI &lt;25. Twenty-seven patients (81.8%) completed the planned treatment and three patients (9%) underwent exclusive radiotherapy after IC. All patients were evaluated for response; 75.7% presented complete response and 21.2% presented partial response. Severe toxicity (grades 3-5) for asthenia, neutropenia, anemia and thrombocytopenia were observed in 6.1%, 9.1%, 6.1% and 3% of patients, respectively. One treatment-related death was associated with febrile neutropenia. The 2- and 3-year PFS rates were 63.3% and 68.4%, respectively; 2- and 3-year OS rates were 62.3.5% and 50.6%. Conclusions: Our results corroborate previous observations that IC (paclitaxel-cisplatin) is a well-tolerated and highly active regimen for the treatment of patients with LASSHNC, being associated with acceptable toxicity, good locoregional control and survival rates. This may be a good treatment option for patients in developing countries.

Head and Neck Cancer Early Identification of Malnutrition High Risk Patients and Quality of Life Optimization

Malnutrition in Head and neck cancer (HNC) patients can be present at the moment of diagnosis. The nutritional status is determinant for the treatment success and quality of life of the patients. The nutritional status gradually declines during treatment and the majority of patients undergoing treatment will need nutritional therapy. On the other hand, HNC, like other cancers, can induce a paraneoplastic syndrome that leads to cachexia. This cachexia status is most of the times the cause of death or the cause of treatment failure. So, early identification of malnutrition high risk patients is crucial to start an adequate nutrition support intervention in HNC patients. This study aims to identify HNC patients who present malnutrition or higher risk of malnutrition; to signalize variables that support early identification of high-risk patients of becoming malnourished and to establish a dynamic relationship between malnutrition risk in these patients and Quality of Life (QoL) impacts. For six months consecutive outpatients with HNC admitted at the Head & Neck Unity of Oncology Portuguese Institute—Porto were asked to participate in the research (n = 114). The European Organisation for Research and Treatment of Cancer (EORTC) cancer-specific HRQoL questionnaire-QLQ-C30 and Malnutrition Universal Screening Tool, MUST were used. At the moment of first presentation, 32 patients (28.1%) presented high-risk of malnutrition. HNC patients with oral cavity and oropharynx tumour locations, older, with low literacy or with BMI under 18.5 at the moment of diagnosis, represent a high-risk group. When HNC is considered, a dynamic and bi-directional connection between malnutrition and QoL is observed. A significant (p Emotional and social functional scales and all symptom scales—including pain, presented significant differences between high and medium risk of malnutrition patients. Fatigue, pain, insomnia, appetite loss and financial difficulties were domains directly related to high risk of malnutrition patients. Pain scores were significantly higher (43.23) in the high-risk patients when compared to medium risk patients (11.67). Nutrition support should be considered at any stage of the pathway —especially in high risk group—in order to optimize tumour treatment results, reduction of adverse effects of therapy and improving both QoL and survival.

Promoter DNA Methylation and mRNA Expression Level of p16 Gene in Oral Squamous Cell Carcinoma: Correlation with Clinicopathological Characteristics.

The aim of this study was to investigate the relationship between p16 methylation and its expression in oral squamous cell carcinoma (OSCC). Also the contribution of clinicopathological factors, HPV infection and smoking in p16 expression and promoter methylation has been investigated. In this study 67 consecutive OSCC patients and 59 normal individuals were enrolled. All patients were candidates for surgery of oral cavity and fresh tumor biopsies were collected and processed for DNA and RNA extraction. Normal gingival tissues were collected from individuals referred to dentistry clinic and considered as controls. All the cases and controls were checked for HPV infection and then promoter methylation and expression of p16 gene were determined using Methylation-specific PCR (MSP) and real-time PCR (QPCR), respectively. Methylation of p16 in tumors and normal tissues were 59.7 and 38.9%, respectively. Most of hypermethylated samples (>82%) were in high grades. P16 methylation was comparable in HPV+ and HPV- patients or smokers. P16 was overexpressed (~3 fold; p = 0.044) in HPV+ tumors, but it was significantly down-regulated in smoker patients (40% of all tumors). Comparison of P16 expression in OSCC tumors with different degrees of promoter methylation further suggest the relationship of methylation rate and down-regulation of P16 expression. The p16 methylation and expression was differentially affected in patients with HPV infection and the smoker cases. Regardless of the influence of environmental factors, it appears that P16 status is useful for classifying patients with OSCC and for influencing treatment strategies in accordance with this classification. Moreover, targeting the upregulation of p16 could be a promising therapeutic option.

Spindle Cell Tumor in Oral Cavity: A Rare Case Report

Spindle Cell Tumor in Oral Cavity: A Rare Case Report

Intra-oral anastomosis as possible approach for mid-face free flap reconstruction

Introduction: Craniofacial resection with adjuvant therapy is usually undertaken for locally advanced sinonasal malignancies. Elective management of the neck differs compared with oral cavity tumours of similar stage, as neck dissection is not mandated. Free tissue transfer is integral in Head and Neck reconstruction, which requires access to vessels for microvascular anastomosis. We describe a series of intra-oral anastomosis in place of conventional cervical access to reduce scarring, facial nerve and parotid morbidity and overcome difficulties related to pedicle length.

Imaging patients with cancer of the oral cavity.

The staging of oral cavity tumours as with all other malignancy subsites is undergoing a revision in the line with the updated American Joint Committee on Cancer guidelines. Of note, the new guidelines incorporate more emphasis on clinical and histopathological data. The aim of the new guidelines is to increase prognostic concordance between stage and survival. This article aims to review the multimodality approach to imaging of oral cavity malignancy. In addition, it will also review the multidisciplinary approach to diagnosis and management of these tumours as multiple specialities are crucial for effective treatment.

Impact of postoperative radiotherapy on survival and loco-regional control in node-negative oral cavity tumours classified as T3 using the AJCC Cancer Staging Manual eighth edition

According to the eighth edition of the AJCC Cancer Staging Manual (AJCC8), a depth of invasion (DOI) >10mm is classified as pT3, representing a locally advanced tumour requiring postoperative radiotherapy (PORT). When node-negative, however, evidence regarding whether PORT improves loco-regional control or survival is unclear. To clarify this, two cohorts of patients were studied: (1) patients classified as pT3N0 by the seventh edition of the AJCC manual (AJCC7), with DOI >10mm and a tumour diameter >4cm (17 patients who received PORT), and (2) patients classified as pT1N0 and pT2N0 by AJCC7, with DOI >10mm and a tumour diameter <4cm (55 patients who did not receive PORT). Loco-regional control and survival were analysed. PORT was found not to impact overall survival or disease-free survival. It was also found not to impact local, regional, or distant recurrence. Although the two subsets of patients considered here (DOI >10mm with tumour diameter below or above 4cm) were previously distinct, they are both considered pT3 in AJCC8. Data from this study indicate that the routine administration of PORT to patients with a DOI >10mm may not be warranted in the absence of other risk features such as nodal disease or close margins.

Solitary Fibrous Tumor of Oral Cavity: Report of Three New Cases

Solitary fibrous tumor (SFT) is uncommon in the oral cavity, predominantly affecting the buccal mucosa and tongue of adult women. We describe here 3 additional cases of oral SFT. All patients were women with a mean age of 52 years (range 41-63 years). The tumors presented as slow-growing, asymptomatic, and well-defined submucosal nodules with a smooth surface, located in the buccal mucosa (2 cases) and posterior lower vestibule (1 case). The latter case measured 5 cm and caused superficial bone erosion of the mandible. Gross analysis revealed whitish fibrous appearance of the cut surface. Microscopic analysis revealed typical circumscribed spindle-cell proliferation, with a variably collagenized stroma and staghorn-shaped vessels, exhibiting positivity for CD34, bcl-2, and CD99. All three patients are well, and recurrence has not been observed after follow-up varying from 6 to 18 months. Clinicians should consider oral SFT when evaluating well-defined nodules in the buccal mucosa.

Subcranial craniotomy in surgical management of advanced oral cavity malignancies: a technical note

Craniofacial resection is the technique of choice for tumors of the oral cavity or paranasal sinus extending close to the skull base of middle cranial fossa. Here we would like to describe a new technique of approaching these tumors through the facial incision itself. All patients treated with this technique at our institute were included in this retrospectively analyzed case series. The pathological clearance margins, complications and outcomes were studied. A total of nine patients underwent resection of tumor with the subcranial approach. There were seven males and two female patients. Mean age was 50.66 years (22–72 years). The diagnosis was squamous cell carcinoma in five patients, adenoid cystic carcinoma in three patients and alveolar soft part sarcoma in one patient. A lip split incision and mandibulotomy/mandibulectomy was done in seven patients; a Weber–Fergusson incision was used in one patient and details were not available in one other patient. Reconstruction was done with anterolateral thigh flaps with or without titanium mesh for all the patients. One patient developed thalamic infarct and was managed conservatively. None of the other patients had complications related to the craniotomy. The infratemporal fossa margin was close/involved in two patients (22.22%). Eight patients received adjuvant therapy without delay. One patient, who had received radiation previously, did not receive adjuvant radiation. This technique aims to reduce morbidity without compromising on the oncological outcomes for tumors extending short of or up to the skull base.