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Background: Submental artery island flap (SIF) is a viable alternative to free flaps for selected oral-cavity defects, however, concerns about its oncologic safety still exists. A novel harvesting technique and its outcome is described in here., Methods: This is a prospective study for patients with lateralized oral tongue and/or floor of mouth (FOM) cancers who undergone reconstruction using pedicled SIF based on contralateral submental vessels (CSIF) following resection., Results: Forty-one patients were included. Twenty-four patients had T2, 13 had T3, and 4 had T1 tumors. The largest flap skin paddle was 15 × 9 cm. One patient sustained complete and five sustained partial flap loss. Three patients developed tongue tethering. Median follow-up was 13.6 months. Locoregional recurrence occurred in 11 patients (26.8%); 6 oral-cavity recurrences (14.6%), 6 ipsilateral, and 1 contralateral neck recurrences (2.4%)., Conclusion: CSIF is a reliable flap that addresses the oncologic controversy and overcomes the disadvantages of ipsilateral flap., (© 2020 Wiley Periodicals LLC.)

Background: Oral tongue/floor of mouth squamous cell carcinoma (OTFMSCC) with a depth of invasion (DOI) > 10 mm involves extrinsic muscles and lingual neurovascular/lymphatic bundles. "Compartmental" hemiglossopelvectomy (CHGP) was developed to improve loco-regional control by "en bloc" removal of tumor and its pathways of spread., Methods: We conducted a retrospective observational study on 45 CHGPs performed at a single institution for OTFMSCC with a DOI > 10 mm at CT/MR. Group A (n = 35) included naïve patients, and group B (n = 10) recurrent cancers. We evaluated 2-year overall survival (OS), disease-free survival (DFS), local control (LC), and loco-regional control (LRC)., Results: Two-year OS, DFS, LC, and LRC were 80%, 91%, 100%, and 94% for group A, and 27%, 26%, 67%, and 36% for group B, respectively. Salvage surgery and positive margins were significantly associated with worse prognosis., Conclusion: CHGP is a reliable oncologic approach in primary surgery for advanced OTFMSCC. In recurrent cancers, survival remains poor., (© 2018 Wiley Periodicals, Inc.)

Background: The purpose of this study was to determine whether the pull-through resection is better than the mandibular lip-split for advanced tongue/floor of mouth (FOM) cancers, which remains inconclusive., Methods: A retrospective cohort study was performed on 91 patients with T4a tongue/FOM cancers from 2009 to 2014. Cases with mandibular resection were excluded. The pull-through resection was used when the mouth opening was ≥15 mm; otherwise the mandibular lip-split was used., Results: Fifty-eight patients received pull-through resections and 33 underwent mandibular-lip splits and the mean follow-up periods were 42 and 45 months, respectively. Surgical margin, locoregional recurrence, and 5-year survival were similar between the 2 groups. The pull-through approach had a significantly shorter operation time, lower rates of flap infection, osteoradionecrosis, metal plate exposure, loss of tooth vitality, and better aesthetics., Conclusion: Our data suggest that the pull-through resection does not compromise disease control for advanced tongue/FOM cancers and is superior to the mandibular lip-split in terms of operation time, postoperative complications, and aesthetics., (© 2017 Wiley Periodicals, Inc.)

Background: Applicability of sentinel node biopsy (SNB) for tumors of the floor of mouth (FOM) is controversial., Methods: Prospective evaluation of the accuracy of gamma-probe-guided superselective neck dissection of the preglandular triangle of level I for SNB in FOM squamous cell carcinoma (SCC) after preoperative lymphoscintigraphy and single photon emission CT (SPECT)/CT., Results: In total, 22 sentinel lymph nodes were harvested in level I. Eight of 22 (36%) were seen on lymphoscintigraphy and 11 (50%) on SPECT/CT. Eleven sentinel lymph nodes (50%) were only detected intraoperatively. In unilateral tumors, 20% were contralateral, and, in midline tumors, 93% showed bilateral level I sentinel lymph nodes. The false-negative rate was 8.3%, the negative predictive value was 96.4%, and the false-omission rate was 3.6%. The ultimate neck control rate, including salvage treatment, was 100%., Conclusion: SNB in FOM can be reliably performed using the presented surgical technique. Level I exploration, bilaterally in midline tumors, is mandatory irrespective of the visualization of sentinel lymph nodes in other levels. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1367-1372, 2016., (© 2016 Wiley Periodicals, Inc.)

Background: The floor of mouth (FOM) is a common site of oral squamous cell carcinoma (SCC). The purpose of this study was to investigate pathological predictors of survival in FOM SCC., Methods: We conducted a retrospective study of 54 consecutive patients undergoing surgery for FOM SCC. Pathological parameters were extracted from histological reports with original pathology slides re-reviewed by 2 pathologists for missing data., Results: On univariate analysis, depth of invasion >10 mm (p = .009), lymphovascular invasion (LVI; p < .001), noncohesive invasive front (p = .006), perineural invasion (PNI; p = .003), and nodal metastases (p = .02) were significant predictors of overall survival. On multivariate analysis, LVI (p = .009) and invasive front (p < .001) remained significant. Postoperative radiotherapy improved survival in patients with LVI, PNI, and nodal metastases, and was just outside significance for noncohesive invasive front (p = .06)., Conclusion: LVI is an adverse prognosticator in FOM SCC and indicates postoperative radiotherapy. Further study is required to investigate the importance of invasive front. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1528-E1534, 2016., (© 2015 Wiley Periodicals, Inc.)

Background: An endoscope-assisted frenotomy approach (EFA) to resection of the median upper neck mass has been introduced to clinical practice. However, its technical feasibility, indications, and safety have not been fully studied. Here, we report the results of a prospective phase II clinical trial to evaluate the clinical outcomes., Methods: Twenty patients were enrolled in this trial. The masses were divided into 3 subtypes. We implemented EFA to remove the masses after receiving informed patient consent. We evaluated the clinical outcomes and complications related to this procedure for more than a 2-year period., Results: EFA successfully removed the masses in all cases without any injuries to adjacent nerves or ducts. During the more than 2-year follow-up period, recurrence or revision surgeries were not required., Conclusion: EFA can be a very effective and safe approach for median upper neck masses, and can also lead to excellent cosmetic and functional results., (Copyright © 2013 Wiley Periodicals, Inc.)

Background: Surgical removal of a dermoid cyst is usually accomplished through an external neck incision. However, this procedure inevitably results in a neck scar., Methods: We report the case of a 17-year-old woman with a submental mass. We implemented a modified approach to dermoid cyst removal through the floor of the mouth using an endoscope system., Results: The patient received a modified approach to dermoid cyst removal and remains free of disease 6 months after excision., Conclusion: Resection of the submental type dermoid cyst can be performed by an intraoral endoscope-assisted approach through the floor of the mouth. We describe the procedure of the endoscope-assisted intraoral resection., (Copyright © 2010 Wiley Periodicals, Inc.)

Background: The radial forearm flap is frequently considered the first choice for tongue reconstruction, but the disadvantages of donor site morbidity are well known. The search for another thin skin flap as an alternative has led to the application of the medial sural artery perforator flap., Methods: We used 12 medial sural artery perforator flaps to reconstruct tongue and floor of mouth following cancer ablation. We paid attention to the major perforator (vein >or= 1 mm) as the vascular relay., Results: Most flaps were raised with a single perforator. The size of the skin paddle varied from 9 cm x 5 cm to 14 cm x 12 cm. The mean thickness of the flap was 5.2 mm. We reexplored 1 patient for venous insufficiency and could not salvage the flap., Conclusions: The thin medial sural artery perforator flap permits high accuracy of tongue restoration and reduces the morbidity at the donor site., ((c) 2007 Wiley Periodicals, Inc. Head Neck, 2008.)

Background: The upper level of a cervical lymphadenectomy is anatomically defined at its anterior extent by the lower border of the mandible and, in surgical practice, by the lingual nerve. A neck dissection completed below this level is generally considered adequate for removal of lymph nodes at risk for metastases from oral cavity cancer. Traditional discontinuous neck dissections do not provide for removal of floor of mouth tissue along with the primary and neck specimens., Methods: A case report presenting biopsies from a T2N2bM0 squamous cell carcinoma of the mobile tongue and adjacent floor of the mouth in a 73-year-old man., Results: Deep biopsy of a ventral tongue and floor of mouth squamous cell carcinoma revealed occult metastatic cancer to lymph nodes located in the superficial floor of mouth associated with the sublingual gland above the lingual nerve. This report identifies floor of mouth lymph nodes that can be involved with cancer and missed through the standard practice of discontinuous neck dissection.Conclusions. This finding offers evidence that, in certain cases, a traditional discontinuous neck dissection may not address all lymph nodes at risk in the treatment of oral cavity cancer. Further investigation into lymph node distribution within the oral cavity is warranted to reappraise the upper limits of cervical lymphadenectomy., (Copyright 2002 Wiley Periodicals, Inc.)

Background: Paragangliomas are unusual tumors in the head and neck originating from the paraganglia or glomus cells of neural crest origin., Methods: We describe the first case of a primitive paraganglioma of the floor of the mouth presenting in childhood., Results: Complete surgical removal was performed after embolization of the left lingual artery. There was no evidence of either persistent or recurrent disease 5 years after surgery. The embryologic and anatomic origins of head and neck paragangliomas are reviewed., Conclusions: An embryologic theory based on the common neural crest origin and migration pathways of both autonomic viscerocranium appended ganglias and paragangliomas is proposed that unifies the topographically heterogeneous group of viscerocranium-appended paragangliomas., (Copyright 2001 John Wiley & Sons, Inc. 2001.)

Background: The submental island flap (SIF) is a new alternative in the reconstruction of various head and neck defects. We present our preliminary experience in the use of this flap and describe the surgical technique., Methods: Nine patients underwent reconstruction with the SIF between January 1998 and July 1999. The SIF has been used for the reconstruction of the cervical esophageal stenosis in 2 patients, floor of mouth and tongue defects in 6 patients, and a hemilaryngectomy defect in 1 patient., Results: With the exception of one partial flap loss caused by arterial insufficiency, no flap failures were observed. All the donor site defects but one were closed primarily. One patient who underwent reconstruction of a hemilaryngectomy defect underwent revision surgery because of intractable hair growth on the transferred skin paddle. Marginal mandibular nerve function was intact in all the cases., Conclusions: When combined with the reported experience of other surgeons, our preliminary experience showed that the SIF was an excellent alternative in the reconstruction of head and neck defects because of its reliability, versatility, and relative ease of application.

Background: Cervical lymph node metastasis has a major influence on survival in oral cancer. However, the factors influencing its occurrence are uncertain. Our aim was to improve the prognostic efficiency of the histologic assessment of the primary tumor in predicting metastasis in an individual patient., Methods: The relationship between selected clinical and histologic features of the primary tumor of tongue/floor of the mouth and the actual metastatic status was investigated in 45 patients. Invasive cell grading was supplemented by histologic measurements of tumor size and assessments of vascular and perineural invasion., Results: Ten histologic features showed significant differences in relation to metastasis. A logistic regression model with two predictor variables (total histologic malignancy score and vascular invasion) classified correctly 39 (87%) of the 45 cases., Conclusions: Histologic assessment of tumor size and malignancy grade are useful in predicting metastasis. Vascular and perineural invasion are important predictors and should be included in multifactorial malignancy grading schemes. Application of the prognostic index to the biopsy specimen would aid in treatment planning.

Between 1978 and 1991, 56 microvascular composite flaps were used for oromandibular reconstructions: 15 for primary total and subtotal tongue reconstruction and five for secondary major tongue reconstruction. The delayed reconstructions were performed to improve the oral and pharyngeal phases of swallowing. Using a floor of the mouth composite bone grafting technique to reposition the tongue and obliterate the oral dead space intraoral food transport was improved (three of five patients), but aspiration persisted (three of four patients). When compared with 10 patients evaluated for primary total and subtotal tongue reconstruction the primary reconstruction group showed superior swallowing (eight dynamic oral transport, no aspiration) and speech results. The poor results of secondary reconstruction are attributed to scarring and irreversible damage to remaining functional muscles involved in protecting the laryngeal aditus.

Videofluoroscopic and clinical data are presented for postsurgical recovery of tongue and hyoid activity during swallowing. Comparison is made to normal controls. Postsurgery, but prior to radiotherapy, both the lingual propulsive gesture and hyoid velocity were slower than normal. These features of the swallow had returned to the normal range following radiotherapy. The general sequencing of swallowing events, and the relationship of the end of the tongue propulsion to anterior hyoid motion were normal in those patients able to swallow. In this patient group, postsurgical radiotherapy did not prevent continued recovery of swallowing function sufficient for oral nutrition.

We have retrospectively reviewed the treatment results of postoperative radiotherapy (RT) for advanced oral cavity cancers. The purpose of this study was to determine the impact of anatomic subsite on the results of treatment. Between 1975 and 1985, 51 patients with squamous cell carcinoma of the oral tongue (OT = 29 patients) and floor of mouth (FOM = 22 patients) were treated with combined surgery plus RT. All had an indication(s) for RT including advanced primary disease (T3 or T4) (29 patients), close or positive margins (34 patients), and multiple positive neck nodes and/or extracapsular extension (41 patients). With a median follow-up of 6 years, the 5-year actuarial local control rate was 74% and the rate of distant metastasis (DM) was 34%. Despite the similar T stage, margin status and median RT dose, the 5-year actuarial local failure rate was 38% for OT vs. 11% for FOM (p = 0.03). Furthermore, the median survival after recurrence was 9 months for OT and 40 months for FOM (p = 0.02). At 5 years the determinate survival for both sites was (55%), and the likelihood of developing a second malignancy was 31%. The likelihood of developing DM was 50% for FOM (N0-N1 = 3 of 12, N2-N3 = 8 of 10) and 21% for OT (N0-N1 = 4 of 21, N2-N3 = 1 of 8). This study highlights significant differences between FOM and OT cancers in response to combined surgery and RT. Future strategies should be directed at the enhancement of local control for OT and better systemic therapy for those with advanced N-stage FOM.(ABSTRACT TRUNCATED AT 250 WORDS)

This is an analysis of 16 patients with excisionally biopsied (TXN0) squamous cell carcinoma of the oral tongue (nine patients) and floor of mouth (seven patients) treated with radiotherapy. All patients had a minimum 2-year follow-up and 81% had at least 5 years of follow-up. One patient died of intercurrent disease 16 months after treatment and was excluded from analysis of local control. All patients were evaluable for analysis of survival and complications. Local control was achieved in 14 of 15 patients; one patient with local recurrence underwent a surgical salvage procedure, which was unsuccessful. No patients developed recurrent disease in the neck or in distant sites. Five-year absolute and cause-specific survival rates were 10 of 13 and 10 of 11, respectively.