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The buccinator flap is currently one of the best techniques for the reconstruction of defects in the oral cavity and other sites. Reconstruction of the palate is a major challenge because of the functional consequences of the excision of lesions in this area. The main goal is to maintain separation between the mouth and the nose. We have done a cross-sectional retrospective descriptive study of a series of cases reconstruction of palatal defects with buccinator flap at the University Hospital Miguel Servet in Zaragoza during a six-year period and compared our results, morbidity, and mortality with those of published series. The main complication was partial loss of the flap. We have analysed the reasons for this and report the steps needed to avoid it., (Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Adenoid cystic carcinoma is the most common malignancy of the minor salivary glands, and its biological behaviour is characterised by slow and indolent growth; rare involvement of regional lymph nodes; a high propensity for perineural invasion; multiple or delayed recurrences, or both; and a high incidence of distant metastases. Our aim was to find out the relation between the presence of perineural invasion and these factors. Between 1 January 1984 and 1 May 2008, 26 cases of adenoid cystic carcinoma of the intraoral salivary glands, which had initially been treated surgically, were reviewed retrospectively. The most common site was the palate, and perineural invasion was reported in 13 of the 26 resected specimens. There was no significant association between it and the size of the primary tumour (OR=1.0; p=1.00), invasion of the surgical margins (OR=2.08; p=0.4), the presence of distant metastases (OR=3.43; p=0.197), or local control (p=0.76). It was exclusively present in patients with local extension, and was significantly associated with outcome (p=0.04). Resection with clear margins is the gold standard of care for patients with intraoral adenoid cystic carcinoma, and the role of adjuvant irradiation remains controversial. Given its paradoxical and complex biological behaviour, large studies with long term follow-up are needed to define the clinicopathological and immunohistochemical variables associated with outcome, as well as the optimal treatment., (Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The purpose of this study was to define the incidence of cervical metastasis in squamous cell carcinoma (SCC) of the maxillary alveolus, hard palate and gingiva; to identify patterns of locoregional failure and to assess survival outcomes. We retrospectively analysed 30 patients treated for SCC of the maxillary alveolus and hard palate between 2000 and 2010. Parameters assessed included the incidence of cervical metastasis at presentation and recurrence, paying particular attention to tumour staging and survival outcomes. Of our 30 patients, 25 were confirmed to have T4 SCC of the maxillary alveolus and hard palate with bone invasion. Cervical metastases had been noted in 7 (23%) patients at initial presentation. A total of 9 (36%) patients developed regional failure in the pT4 SCC group shortly after primary resection. Patients with advanced primary SCC of the hard palate and maxillary alveolus (particularly when there was bone invasion) showed high rates of regional failure, and in most cases successful salvage was not achieved. Based on our findings and a review of the existing literature we strongly recommend elective neck dissection for patients with pT4 SCC of the maxillary alveolus and hard palate., (Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The coexistence of different types of malignancy in cervical lymph nodes has been reported previously. We report the first case, to the best of our knowledge, of concurrent metastatic adenoid cystic carcinoma and squamous cell carcinoma (SCC) in cervical lymph nodes. A primary SCC developed three decades after treatment for adenoid cystic carcinoma of the palate, and the synchronous metastases became clinically apparent the following year. The aetiology of the SCC may have been related to radiotherapy or smoking. Whether the adenoid cystic carcinoma would have remained dormant, or was reactivated after perturbation of host defence mechanisms, is not known., (Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Distant metastases from oral squamous cell carcinoma are unusual, but generally occur in lungs, bone, and liver. Cutaneous metastasis is extremely rare, and it often reflects an advanced stage with sinister prognosis. The authors report an 81-year-old male patient with multifocal cutaneous metastases from a recurrent squamous cell carcinoma of the hard palate 5 months after primary treatment., (Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Adenoid cystic carcinoma is a tumour of glandular cells responsible for 10% of salivary gland neoplasms. It has a high rate of perineural spread but limited involvement of regional lymphatics even in late stage disease. Early survival is typically good (60-90%) although long term survival is poor with spread to distant sites in 40-60% of cases. The authors performed a retrospective review of clinical and pathological records for 24 patients managed by their institution over a 22-year period. The overall 5, 10 and 20-year survival rates in this study were 92%, 72% and 54%, respectively. Perineural invasion was seen in 63% and close or positive margins seen in 64% of all primary resection specimens although survival was not associated with any clinical factor other than the initial size of lesion. Most patients presented complaining of a lump, whilst a burning neuralgia-type pain was the second most common symptom. The study confirms the conclusion of previous studies that tumour size at diagnosis is the most important predictor of outcome., (Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Teratomas of the head and neck are uncommon congenital lesions, which are rarely seen in the soft palate. We here reported a male neonate with a soft palate teratoma associated with soft palate cleft. The most common presenting symptom of oral teratoma is feeding problems. The tumour looks like a mushroom, and was successfully treated with surgery. Feeding returned to normal by removing the mass, and the patient is under follow up for selective operation of the cleft palate. This case is unique because teratoma in a mushroom shape was not reported before., (Copyright 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

We retrospectively studied 17 patients with squamous cell carcinoma (SCC) of the maxillary gingiva, alveolus, and hard palate who were treated over a 7-year period (2000-2007) to investigate whether selective neck dissection is justified at an early stage. Four patients presented with metastases in the neck, and all developed early recurrence in the neck, with poor prognosis. Of the 13 patients who initially had no sign of metastases, two developed regional metastases within the first 18 months of initial treatment. Squamous cancers of the maxillary gingiva, alveolus, and hard palate should be treated aggressively, and elective neck dissection should be considered because of the high risk of occult metastases. Prospective studies are difficult because of the rarity of the tumour., (Copyright 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Although calcification is a common finding in inflammatory salivary gland disorders, salivary gland tumour rarely shows calcifications. A case of clear cell mucoepidermoid carcinoma (MEC) of the hard palate with extensive intratumoural calcifications visible on computed tomography (CT) scans and histologic sections is described. The calcification in the salivary gland tumour of the palate recognized by a CT scan should be considered in the differential diagnosis of a MEC. The mechanism of the intratumoural calcification in our case is speculated to be a result of a secretory function of the tumour cells.

We report a very rare case of double cancer involving palatal malignant melanoma and gastrointestinal stromal tumor (GIST), a rare tumor of the gastrointestinal tract originating from a primitive mesenchymal cell. After chemotherapy, radiation therapy, and treatment with interferon and OK-432, the GIST was resected and the melanoma disappeared. The patient has had no evidence of recurrent tumor, and the patient's clinical course has been uneventful for 1 year. This is probably the first report of synchronous double cancer involving oral malignant melanoma and GIST.

When the current T classification of the UICC (1987 and 1997) is used to stage carcinomas arising the upper alveolus and gingival and hard palate, most cases are classified as T4 because of their anatomic characteristics, similar to carcinomas arising in the lower alveolus and gingiva. This study compared the following two methods for classifying the T stage of maxillary carcinomas: (1) the original T classification criteria proposed by the UICC (1987 and 1997), and (2) a new T classification criteria, called the sinus and nasal floor (SNF) criteria. We found that the SNF criteria were more closely related to tumor control and survival than were the UICC criteria in patients with carcinomas arising in the upper alveolus and gingival and hard palate. Increased use of the SNF criteria is expected to improve staging of gingival tumors arising in the maxilla and increase the accuracy of diagnosis, especially of T4 tumors.

Synovial sarcoma is a rare soft tissue tumour of uncertain histogenesis and intraorally they occur mainly in young adults. We present a case of synovial sarcoma of the hard palate in a 68-year-old woman. To our knowledge, there is no previously reported instance of this tumour at this site.

Polymorphous low-grade adenocarcinoma (PLGA) is an uncommon tumour that usually affects the minor salivary glands, particularly in the palate. It is rare in young patients, and here we report a case in a teenage girl. She presented at the age of 16, although the lesion had been noticed 2 years previously. The tumour showed histopathological features of PLGA, but recurred locally, behaved aggressively, and ultimately metastasised to cervical lymph nodes. This was accompanied by an altered histological picture, with a papillary cystic pattern and necrosis becoming progressively more prominent. PLGA is not always a low-grade lesion and some tumours, notably those with a papillary cystic growth pattern, may require more aggressive treatment.

Oral amelanotic melanomas are rare and the prognosis is poorer than that of pigmented melanomas because of delays in establishing the correct diagnosis and in the initiation of treatment. Amelanotic forms are also thought to be biologically more aggressive than pigmented melanomas. We have seen three cases of oral amelanotic melanomas since 1970, in two of whom the diagnosis was long delayed. Two lesions were not pigmented but one had slight pigmentation. One patient simultaneously had both an amelanotic and a pigmented melanoma in the oral cavity. Lymph node metastases and distant metastases developed in all patients, two of whom eventually died of the disease. Early diagnosis by histological examination together with immunostaining with S100 and HMB-45 are the keys to improve survival for patients with amelanotic melanoma., (Copyright 2002 The British Association of Oral and Maxillofacial Surgeons.)

From March 1991 to February 2001, 80 cases of minor salivary gland tumours were diagnosed in the Department of Oral and Maxillofacial Surgery at the University of Maryland at Baltimore (Baltimore, MD, USA). Data extracted from a retrospective chart review included age, sex, symptoms, site, histological diagnosis. treatment and outcome. Pleomorphic adenoma was the most common benign tumour and makes up 89.5% of all benign tumours. The percentage of malignancy (76.3%) was much higher than that found in other studies. Of the malignant tumours, 54.1% were mucoepidermoid carcinomas. This study differs from many previous reviews that were published by pathologists rather than a surgical unit.

Lymphoepithelioma-like carcinoma is a rare tumour in the oral cavity and is characterized histologically by non-keratinizing, undifferentiated squamous cell carcinoma with lymphocytic infiltration. Three consecutive cases of intraoral lymphoepithelioma-like carcinoma are reported. A review of the literature reveals a similar biological behaviour to that of nasopharyngeal lymphoepithelioma: a high incidence of cervical nodal spread and remarkable radiosensitivity. Chemotherapy should be considered when nodal or distant metastases are present. The association of the Epstein-Barr virus with this tumour remains unclear but our experience suggests a positive correlation in Chinese individuals.

Glomus tumours are usually small benign neoplasms that occur in the dermis or subcutaneous tissues of the extremities. They are rare in the oral cavity, only 18 cases having been reported in the medical journals to our knowledge. They arise from the epithelioid glomus cells that normally reside in the stratum retinaculare corii of the skin and are concerned with temperature regulation. We report the clinical, morphological and immunohistochemical features of a case of glomus tumour of the hard palate., (Copyright 2001 The British Association of Oral and Maxillofacial Surgeons.)

A case of minor salivary gland clear cell adenocarcinoma of the palate with metastasis to the lungs in a 53-year-old female is presented. Histologically, the cells were characterized by glycogen rich clear cells arranged in solid nests, trabeculae, surrounded by hyalinized fibrous stroma. We believe this represents an aggressive form of this type of tumor.

We present two cases of histologically confirmed intracerebral metastases from oral squamous cell carcinoma (SCC). This site of distant spread has not to our knowledge previously been reported. The only common feature in all these cases was the long period over which the patients had untreated primary disease (12--24 months). Both patients developed symptoms from their cerebral deposit within a short time of diagnosis and treatment of the primary disease. They died rapidly of their cerebral metastases despite extensive and effective treatment of the primary site and regional lymph nodes. We recommend that a magnetic resonance (MR) scan of the brain is considered for patients who present with long-standing untreated primary oral SCC., (Copyright 2001 The British Association of Oral and Maxillofacial Surgeons.)

The present study was undertaken in order to determine whether surgical treatment of oral leukoplakia reduces the risk of the subsequent development of carcinoma. This study included 142 patients with oral leukoplakia who received or did not receive surgical treatment. All subjects were followed-up for more than 6 months with a mean follow-up period of 4 years. Malignant transformation rate was lower among patients who received surgical excision (1/75) than among those who did not receive surgical treatments (4/51). However, the malignant transformation rates were high in patients who received cryosurgery (3/12) or cryosurgery plus surgical excision (1/4). There was no obvious relation between the grade of epithelial dysplasia and the rate of malignant transformation. Our results suggest that surgical excision of oral leukoplakia may reduce the risk of the subsequent development of carcinoma.

Malignant mucosal melanoma represents 0.3 to 10% of all melanomas. The majority of these lesions arise in the oral cavity or paranasal sinuses. Very few authors report reliable treatment results, however all suggest a uniformly poor outcome. A retrospective analysis of all cases of upper aero-digestive tract melanoma (UADT) treated since 1982 at our centre are presented. During the 15-year period, nine cases of UADT melanoma were identified. Three patients had a lesion in the palate, two in the maxillary alveolus, two in the oropharynx, while one each had a lesion in paranasal sinus and lower alveolus. Mean age was 43.25 years (28-62 years), with a male to female ratio of 1.6:1. Cervical lymphadenopathy was the commonest presenting symptom in seven patients. Radical surgery was carried out in three patients, wide excision in three and radical neck dissection in six, while no surgical intervention was undertaken in two patients. Median follow-up time was eleven months. In four patients, local recurrence occurred, while three developed pulmonary metastasis. One patient was lost to follow-up. We suggest that data from various centres be pooled together in order to carry out a meta-analysis to address the question of optimal treatment for malignant melanoma of the upper aero-digestive tract.

Ninety-one cases of adenoid cystic carcinoma (ACC) of the salivary glands with more than ten years' follow up were studied to investigate factors influencing the survival rate of patients, which vary according to site, histological type, clinical stage and nature of therapy. The data were statistically analysed for survival curves. Log rank tests were employed to assess the statistical significance of various groups. As a result, it may be concluded that tumour site, clinical stage and histological type are the important factors influencing the prognosis. ACC of the palate and parotid, early clinical stage, glandular/tubular histological type, and tumour without nerve involvement had the best prognosis. ACC in the submandibular gland, maxillary antrum and tongue, advanced clinical stage (stage III and IV), solid histological type, and tumour with nerve involvement had a poor prognosis.

A case of cervical lymph node metastases of polymorphous low grade adenocarcinoma is reported, originating from a minor salivary gland in the soft palate in a 76-year-old man, 19 years after initial presentation. The clinical course, histopathology, and literature review on the metastatic aspect of the tumour are presented. This has emphasized the need for increased awareness of this recently described tumour and the need for lifelong follow up.

Salivary gland tumors are rare in infancy, and almost all of them are found in the parotid gland. Minor salivary gland tumors are even more rare, pleomorphic adenoma being the most frequently involved tumor. Only six well-described cases of pleomorphic adenoma arising in the palate have been reported in children. A case occurring in a 16-year-old boy is presented.

12 cases of acinic cell carcinoma diagnosed in Northern Ireland from 1942 to 1982 on which there was at least 10 years' follow-up were reviewed, by pooling cases from all regional pathology laboratories. Clinical findings at presentation were established from case notes, together with details of eventual clinical outcome. Sections were examined to determine tumour size, morphological pattern and cytological constitution, the presence or absence of cytological atypia, mitotic activity, lymphocytic and desmoplastic responses, and to assess for infiltrative margins and adequacy of excision. The tumours arose in 8 females and 4 males, aged 22 to 86 years at presentation. Eleven tumours were in the parotid, one in the soft palate. Two patients suffered local recurrence, both more than 7 years after diagnosis. Five patients had regional lymph node metastasis, four at presentation. No patient suffered haematogenous metastasis or died of tumour. Of the features examined, incomplete excision increased the risk of local recurrence. While numbers are small, the acinic cell carcinoma in Northern Ireland is an unpredictable low-grade malignant tumour which is capable of recurrence and metastasis. Adequate excision at presentation appears to be the most appropriate therapy.

Oral malignant melanoma is fortunately a rare lesion. However the actual incidence in the population at present is unknown but may be increasing. The overall prognosis remains poor despite more radical surgery with adjuvant radiotherapy, chemotherapy and immunotherapy. The clinical presentation of oral malignant melanoma can vary widely from a typically pigmented macular or proliferative lesion to a non-pigmented soft vascular tumour; single or multiple, primary or metastatic. Our experience of five patients with malignant melanoma of the oral cavity is presented and the management of such lesions discussed.

Glomus tumours are benign vascular tumours, usually located in the skin. Intra-oral glomus tumours are rare. A glomus tumour of the palate is reported, only the fifth such case out of a total of 14 intra-oral glomus tumours in the world medical literature.

Sialadenoma papilliferum is a rare benign tumor of salivary gland origin. A case is described of a 46-year-old man with an exophytic lesion at the junction of the hard and soft palate. The literature is briefly discussed.

Clinical and radiological features of an epignathus of the soft palate and oropharynx are presented. The case was conservatively treated and followed for 8 years.

A case of B-large cell non-Hodgkin's lymphoma (NHL) with multilobated nuclei arising in the palatal mucosa is described. Immunologic typing of tumor cells was crucial to determine the exact cell of origin of this lesion.

A case of acinic cell tumor arising on the hard palate in a 46-year-old Japanese woman is reported. The clinical and histologic features are described, and treatment discussed.

Intraoral malignant melanotic schwannoma is an extremely rare tumor. Two cases are presented, one occurring in the mandible of a 62-year-old man, the other in the maxilla of a 79-year-old man. The clinical presentation, light microscopic findings and immunohistopathological features are described. The difficulty of diagnosing this special tumor at initial presentation correctly, is discussed.

The intramedullary solitary plasma cell tumour is an invasive tumour of plasma cells. Three cases of solitary intramedullary plasmacytoma and one case of follicular lymphoma with marked plasma cell component are described. The diagnostic and therapeutic difficulties are discussed.

A case of primary epithelioid sarcoma of the hard palate is described with no evidence of metastases. Review of the literature revealed no other reported cases of epithelioid sarcoma at this site. The patient, a 20-year-old male negro, returned with 2 local recurrences after initial excision but with no evidence of metastases. He remains well with no evidence of disease at present. This report records a unique primary site for this tumour, and illustrates the diagnostic difficulties, both clinical and histological, which this tumour may present.

In 90% of cases of AIDS-associated Kaposi's sarcoma (KS), the lesion is observed in the oral cavity. Oral KS usually reveals distinct clinical features characterized by a brown-bluish or otherwise pigmented appearance. The histological features are identical to classical KS. The occurrence of a non-pigmented oral KS in 2 male homosexual patients has prompted the present case reports. Clinicians should be aware that not all cases of AIDS-associated oral KS appear as brown or purplish tumors but may present without any discoloration.

A rare case is described of congenital teratoma protruding from the mouth (epignathus) attached to the hard palate in an infant of 3 days. Typical teratoma components and brain tissue were noted. A description of the relevant clinical and pathological features is given and the embryological basis for the aetiology of the lesion is discussed. The literature is reviewed.

A report of a case of bilateral granular cell tumors of the soft palate is presented. This is an unusual location for the tumor and is the first report of bilateral tumors at this site.

45 squamous cell head and neck cancers including 36 with carcinoma of the oral cavity and 9 with carcinoma of the maxillary sinus were examined immunohistochemically for the presence of CEA. 12 of 30 carcinomas of the oral cavity and 7 of the 9 carcinomas of the maxillary sinus had tumors containing CEA. This difference in the occurrence of CEA was statistically significant. The mean plasma CEA level of 36 patients with carcinoma of the oral cavity and 7 patients with carcinoma of the maxillary sinus was 1.95 +/- 1.72 ng/ml and 3.70 +/- 3.53 ng/ml, respectively. Significant elevation of plasma CEA levels was found only in the stage-IV group patients with carcinoma of the oral cavity as compared with the stage-I group patients. In the 3 patients having plasma CEA values exceeding 5 ng/ml at the time of pretherapy, plasma CEA levels were decreased to below 2.5 ng/ml with the cancer treatment followed by the complete remission. These findings indicate that plasma CEA as a tumor marker in squamous cell head and neck cancer is meaningful in a small proportion of the cancer patient population.

A case of chondroid osteosarcoma of the maxilla is reported. This is itself a rare lesion but in this instance diagnosis was made more difficult for 2 reasons. On presentation, there was little radiological evidence of bone destruction and also, during follow-up and before biopsy-proven diagnosis, the lesion showed considerable evidence of repair on 2 occasions.

The malignant Triton tumour is a malignant schwannoma with rhabdomyoblastic differentiation. This is the first report of this type of rare, aggressive sarcoma arising in the maxilla and only the third report of this type of pathology arising outside the context of von Recklinghausen's disease. Aspects of clinical and histopathological diagnosis are mentioned.

2 cases of unifocal T-cell lymphomas, predominantly large cell type, one restricted to the midline of the palate and the other involving the nasal cavity are reported. Monoclonal antibodies served as a useful adjunct to light microscopy in diagnosing these tumors.

Rhabdomyosarcoma is one of the most common malignancies of the mesenchymal tissue in the head and neck region. A case of a 26-year-old male with oral rhabdomyosarcoma is presented. The clinical and pathologic aspects of this malignancy are also reviewed. Furthermore, the histopathologic and ultrastructural features of this neoplasia are described and the important role of electron microscopy in diagnosis of the myogenic tumor is emphasized. Finally, different modes of treatment for the rhabdomyosarcoma are discussed.

A case of inverted papilloma (Ringertz tumour), which presented as a palatal swelling, is reported. The tumour involved the antral and nasoethmoidal complex. An approach to reconstruction of the palate after removal of the tumour is described.

Conflict exists with respect to the type of pleomorphic adenoma (PA) most likely to recur and whether the possibility of recurrence can be determined by the histology of the lesion. In this study, specific clinical, histological features and treatment modalities were examined in 53 intra-oral PA's with respect to their relevance to the diagnosis and prognosis. No correlation was found between the duration of symptoms and the proportion of stroma in the PA's nor was there any correlation between the size and the duration. However, at the time of diagnosis, the stroma-poor tumours had attained a significantly larger size than the stroma-rich tumours. This may suggest that the cellular tumours grow at a faster rate. Hyaline cells were shown to be a distinct feature of intra-oral PA's, especially in the stroma-poor subtypes. The proportion of the stroma and the capsule integrity do not seem to influence the prognosis. Follow-up information was obtained for 51% of the patients, and despite the fact that the majority of the lesions (33/53) were treated by excisional biopsy, no recurrences were reported. The follow-up period ranged from 0.6 to 12.6 years (mean 5.3 years).

A review of the literature on reverse smoking is presented, followed by a report of a case of reverse smoking in a 59-year-old woman, living in the Netherlands. This is the first report of a case of reverse smoking in the Netherlands so far. The clinical and histological findings are in accordance with those found in the literature. The patient refused to give up her habit. During the 4 years follow-up period, no clinical changes were noticed.

The case of a 30-year-old male with acinic cell carcinoma of a minor salivary gland of the palate is presented. The clinical, histological and ultrastructural features are described, and the treatment is discussed.