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Background: Oral tongue is one of the common site for carcinoma. 22% to 39% of oral cancer develops at this site. The high incidence of cervical lymph node metastasis, occult cervical metastasis, Provide a logical basis for treatment of the neck. The aim of this is study was to find out the importance of selective neck dissection in primary T1, T2, N0 Neck Oral Tongue Carcinoma. Methods: This cross-sectional study was conducted in the Department of Otolaryngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital and National Institute of ENT, Dhaka. Thirty cases of primary T1, T2, N0 Neck Oral Tongue Carcinoma with inclusion criteria was enrolled as a study sample. Patients were evaluated by a complete clinical head and neck examination as well as Imaging (MRI) of the primary tumor and neck. All the data were compiled and sorted properly and the numerical data were analyzed statistically. The results were expressed as percentage and mean ± SD. Chi-square (x2) test or Fisher’s Exact test was done for comparison of data presented in categorical value and p value

The purpose of this study was to evaluate which radiological depth of invasion (r-DOI) measurement is the most concordant to clinical DOI (c-DOI) derived from correction for the shrinkage rate of the histopathological specimens.We retrospectively reviewed 128 patients with tongue carcinoma who had undergone glossectomy between 2006 and 2019. At first, the width shrinkage rate during formalin fixation and preparation process of histopathological specimens was evaluated. From the shrinking rates, a formula to calculate c-DOI from pathological DOI (p-DOI) was developed. The correlation between c-DOI and r-DOI was evaluated.The specimen shrinkage rate during the histopathological specimen preparation process was 10.3%. Based on that, we yielded the correct formula for c-DOI based on p-DOI and preparation shrinkage rate: c-DOI = p-DOI × 100/89.7. The regression equations for the association of c-DOI with r-DOI measured by ultrasound (n = 128), MRI before biopsy (n = 18), and MRI after biopsy (n = 110) were y = 1.12 * x + 0.21, y = 0.89 * x − 0.26, and y = 0.52 * x + 2.63, respectively, while the coefficients of determination were 0.664, 0.891, and 0.422, respectively. In conclusion, r-DOI using MRI before biopsy most strongly correlated with c-DOI.

The aim of this study was to evaluate the correlation and accuracy of depth of invasion (DOI) measurement from preoperative contrast-enhanced computed tomography (CECT) scans in comparison to histopathological examination (HPE) in oral tongue squamous cell carcinoma (OTSCC). Preoperative CT scans of 18 OTSCC patients were reviewed retrospectively by a single observer to measure the DOI on axial and coronal sections; these were then compared to the HPE report. Mean DOI was compared between CECT and HPE using repeated measures ANOVA. The strength of correlation of CT-derived tumour depth was determined using the intra-class correlation coefficient (ICC) followed by assessment of accuracy by Bland-Altman plot. In general, the measurement of DOI was smaller on CECT, with a mean difference of 0.743mm on axial CT and 1.106mm on coronal CT. Regarding the correlation between CECT and HPE tumour depths, ICC was 0.956 for axial CT and 0.965 for coronal CT. Bland-Altman analysis showed that DOI from CECT and histopathological depth were in agreement with each other. In conclusion, there was excellent correlation and accurate measurement of DOI from CECT.

Background Survival rate for oral tongue squamous cell carcinoma (OTSCC) is still poor and, despite Tumor-Node-Metastasis staging system has been recently updated, patients included under the same stage still show difference in prognosis. Perineural invasion (PNI) emerged to be an indicator of tumor aggressive behavior and unfortunate events. In this study, we investigate the clinic and prognostic value of PNI in a cohort of OTSCC patients. Methods About 200 patients with OTSCC were retrospectively evaluated the presence of PNI. PNI was furtherly descripted as uni-/multifocal and as intra-/peritumoral. Disease-Specific and Relapse-Free Survival (DSS; RFS) were estimated; moreover, we included PNI in the current AJCC 8th Staging System, improving the prognostication model. Results Perineural invasion was found in 40.5% of patients. Intratumoral PNI predicted patients at high risk of being diagnosed with lymph-node metastasis. Tumors with positive PNI reported a worse DSS (Hazard Ratio=1.878, p-value = 0.008). Moreover, patients exhibiting both multifocal intra- and peritumoral PNI reported poorest DSS (Hazard Ratio = 2.409, p-value = 0.010). Patients were reclassified in a new staging system in case of multifocal PNI, providing better stratification capacity. Conclusions Perineural invasion might serve as an additional prognostic factor in OTSCC, and by integrating PNI in the staging system, further improvements in prognostication might be reached.

OBJECTIVES/HYPOTHESIS Occult lymph metastasis is an important prognosticator for the treatment of early oral tongue squamous cell carcinoma (SCC). The objective of this study was to evaluate the prognostic significance of tumor-infiltrating lymphocytes (TILs) in early oral tongue SCC. The combination of the TIL subtype and intermediate- or high-grade budding scores was investigated as a prognostic marker for occult neck metastases. STUDY DESIGN Retrospective study. METHODS Specimens from 62 patients with early oral tongue SCC treated with only primary surgery were analyzed by immunohistochemistry for CD4+, CD8+, FoxP3+, and CD45RO+ T cells and CD163+ macrophages. The highest number of each TIL subtype was counted in two areas of parenchyma and stroma in the tumor (Tumor) and peripheral stroma of the invasion margin. RESULTS Based on multivariate analysis, a high density of Tumor CD163+ macrophages served as the poorest prognostic factor for regional control (RC) and disease-free survival (DFS). Patients with both a high density of Tumor CD163+ macrophages and an intermediate- or a high-grade budding score had a poor prognosis for RC according to the log-rank test. CONCLUSIONS In summary, each TIL subtype may use different mechanisms during early and advanced stages of oral tongue SCC. A high density of Tumor CD163+ macrophages was determined to be a risk factor for RC and DFS as well as an additional stratification factor for RC in patients with intermediate- or high-grade budding scores. Therefore, identifying TIL subtypes in daily clinical practice can help determine a more successful and individualized therapeutic approach for early oral tongue SCC. LEVEL OF EVIDENCE Step 4 (Level 4) Laryngoscope, 131:2512-2518, 2021.

Objective To carry out a meta-analysis of prospective literature comparing the clinical efficacy of elective neck dissection (END) vs observation (OBS) in patients with early-stage cT1/T2N0 tongue carcinoma. Design/setting/participants/outcome measures We systematically reviewed four databases from inception to 30-October-2020. We considered all studies meeting the following PICOS conditions: (a) Patients: early-stage cT1/T2N0 tongue carcinoma, (b) Intervention: END, (c) Comparator: OBS, (d) Outcomes: local tongue recurrence, cervical nodal recurrence, disease-specific survival (DSS) rate, and disease-free survival (DFS) rate and (e) Study design: prospective reports. We pooled dichotomous data as relative risks (RRs) with 95% confidence intervals (CIs). Results Four studies (one case-control study and three randomised controlled trials) met our inclusion criteria. There were 448 eligible patients (225 and 223 patients were treated with END and OBS, respectively). END significantly correlated with improved DSS rate (RR = 1.15, 95% CI: 1.04-1.27, P = .007). Nonetheless, there were no significant differences between END and OBS groups regarding the rates of local tongue recurrence (RR = 1.23, 95% CI: 0.50-3.03, P = .65), cervical nodal recurrence (RR = 0.45, 95% CI: 0.16-1.27, P = .13) and DFS rate (RR = 1.08, 95% CI: 0.91-1.27, P = .38). Pooled analysis for cervical nodal recurrence was heterogeneous, and sensitivity analysis revealed a significantly lower cervical nodal recurrence rate in favour of END group (RR = 0.30, 95% CI: 0.13-0.67, P = .004). Conclusion END correlated with a significant decrease in cervical nodal recurrence and improved DSS rate. END might be superior to OBS in patients with early-stage cT1/T2N0 tongue cancer.

Objectives This study aimed to clarify the accuracy of intraoral ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) in preoperative image depth of invasion (DOI) measurement of T1/T2 tongue cancer through comparison with histopathological measurements. Methods Imaging of the primary lesions was performed at our hospital; the lesions were classified into T1 and T2 based on the 8th edition of the AJCC/UICC, and surgery performed. There was histopathological confirmation of lesions as squamous cell carcinoma in 48 patients with tongue cancer. T3 and T4 cases, cases in which preoperative chemotherapy and radiation therapy were performed, and cases where biopsy was performed before imaging were excluded. The radiological DOI in US, CT, and MRI and the histopathological DOI as base were comparatively investigated and statistical analyses were performed by Bland–Altman analysis and Spearman's rank correlation coefficient. Results Bland–Altman analysis showed that the US radiological DOI was overestimated by an average of 0.2 mm compared to the histopathological DOI, while CT and MRI radiological DOI were overestimated by an average of 2–3 mm. The comparison of CT and MRI revealed that the difference between the MRI and histopathological DOI, as well as the 95% limit of agreement, were smaller than those of the CT radiological DOI. Conclusions US is the most accurate preoperative diagnostic tool for T1 and T2 squamous cell carcinoma; CT and MRI tend to have an overestimation of about 2–3 mm and so caution is required.

Chievitz’s organ, or the so-called juxtaoral organ of Chievitz’s, is one of the normal structures located in the deep soft tissue around the medial pterygoid muscle at the height of the piercing mandible line. Although it has been first reported more than a century ago, its function remains unclear. Moreover, there were some reports stating that Chievitz’s organ could be a clinical pitfall due to the similarity of its pathological feature to that of squamous cell carcinoma (SCC). In this report, we describe a case of tongue carcinoma in a 59-year-old man, whose determination of margin free line was quite challenging due to the existence of Chievitz’s organ, which could narrowly avoid unnecessary additional resection. This patient received hemiglossectomy with neck dissection and immediate reconstruction using a radial forearm flap based on the result of imaging data and biopsy. Although intraoperative rapid diagnoses around the surgical margin were all negative, epithelial cell nests composed of small heterotopic cells were found in the permanent specimen from another slice of the same specimen. Fortunately, we achieved the final diagnosis of Chievitz’s organ in a timely manner through a detailed pathological examination using serial sections of the area between the tumor edges together with these findings, which was quite tough. If it was found during surgical treatment, there was quite a possibility that additional unnecessary resection would have been performed. This case demonstrates the importance of the knowledge on Chievitz’s organ for not only clinicians but also pathologists.

Background: Carcinoma of oral tongue is the most common oral cancer and because of its structure and function is prone for early local and regional spread of cancer. The final outcome of a primary tongue carcinoma patient depends upon various prognostic factors like thickness of tumor, depth of invasion, size of lesion and neck node 67metastasis. Risk of metastasis and spread to neck nodes increases with increase in tumor thickness Methods: This prospective observational study was carried out in the Department of Otolayngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for 18 months. Thirty patients with early oral tongue carcinoma i.e.T1 & T2 as per UICC and AJC criteria were included in this study by purposive non-randomized sampling technique. Result of the study were expressed as mean, standard deviation (+SD), frequency and percentages. Unpaired Student’s t-test and Pearson’s correlation co-efficient (r) test were performed. Results: Result of the study showed the mean (+SD) thickness of the tumor was 3.62 (+1.46) mm. Minimum thickness 1.1mm and maximum thickness 7.8mm. Only 21 (70%) subjects neck node were metastasized from tongue and mean (+SD) tumor thickness of the positive neck node metastasis was 5.54 (+1.07) mm and negative neck node metastasis was 2.87 (+0.75) mm. This indicated a significant difference between the groups. Pearson’s correlation co-efficient r (+0.981) which indicated tumor thickness was positively correlated with neck node metastasis. Conclusion: Tumor thickness of the early oral carcinoma positively correlated with neck node metastasis. Correlation between thickness and metastatic lymph node can help planning the treatment regimen and indicate the disease prognosis. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 25-35

Oropharyngeal carcinoma is uncommon cancer compared to other malignancies. It accounts for less than 3% worldwide cancer and classified under the head and neck carcinoma. Patients with locally advanced oropharyngeal malignancy are usually treated with surgery with combination of radiotherapy and chemotherapy. This later required regular follow up especially on supportive care and adaptation to swallowing. Difficulty in swallowing provided burden to the patient and may lead to underlying malnutrition and risk of infection including tuberculosis. This will end up with poor compliance to oral treatment and risk of resistance. Therefore, this case study is illustrating the challenging role of family medicine specialists in managing a case of sputum positive pulmonary tuberculosis with underlying swallowing difficulty from glossectomy and radiotherapy on top of defaulted tongue carcinoma supportive care follow up.

Aims and objectives (1) To study the depth of tumor invasion in an oral (tongue and buccal mucosa) carcinoma and its correlation with neck metastasis. (2) To know whether the increase in depth of tumor (depth of invasion) increases the chances of cervical nodal metastasis in the oral tongue and buccal mucosa carcinoma and derive cutoff value of depth of invasion at which the metastasis occurs. Materials and methods The study was carried out on 14 tongue and 22 buccal mucosa cases to know the correlation between the depth of tumor and neck node metastasis in the oral (tongue and buccal mucosa) carcinoma. Results Among 36 cases, 10 cases were pN+. Out of 10 cases, 7 (70%) were having depth ≥12 mm and 30% cases (pN+) having depth between 8 and 10 mm and among them 4 were pN+ and among 14 tongue cases, 3 cases had DOI >8 mm and all of them were pN+. Conclusion For tongue 8 mm and for buccal mucosa, 10 mm of the depth of tumor invasion was calculated as the cutoff depth, above which the incidence of nodal metastasis increases to 75% and 66.66%, respectively. Clinical significance Depth of tumor is an important prognostic indicator in the tongue and buccal mucosa carcinoma to know the cervical nodal metastasis. Hence for an increase in depth of tumor cases, neck must be addressed along with primary tumor excision. Radiological investigations [ultrasonography (USG), magnetic resonance imaging (MRI), computed tomography (CT) scan] play an important role in nodal metastasis detection hence should be considered in carcinoma of the oral tongue and buccal mucosa especially in clinically N0 neck. How to cite this article Shah AH, Parikh RP. Clinicopathological Correlation between Depth of Tumor and Neck Node Metastasis in Oral (Tongue and Buccal Mucosa) Carcinoma. Int J Head Neck Surg 2021;12(1):6–10.

The aim of this study was to compare magnetic resonance imaging (MRI) features of reconstruction with locoregional flaps (LRFs) with free flaps (FFs) after surgical treatment for tongue cancer.In total, 115 cases of postoperative tongue carcinoma (67 cases of LRF surgery and 48 cases of FF surgery) were retrospectively reviewed. All patients had undergone nonenhanced and contrast-enhanced MRI at 0-4, 5-12, and 13-48 months after surgery. Signal intensity, margins, maximal size, contrast enhancement, change in the hyoglossus and mylohyoid muscles, recurrence, lymph node metastasis, and complications were evaluated.Significant differences were found between LRF and FF for signal intensity (P.001) in all 3 periods, with LRF mostly isointense with muscle on T1-weighted images (T1WIs) and FF producing mixed hyperintensity with muscular striations in all cases in T1WIs and T2-weighted images (T2 WIs). Margin definition was similar between groups in the early period, but sharp margins were more common in FF after 4 months (P ≤ .018). LRF was significantly smaller than FF in all periods (P ≤ .017). Both mylohyoid and hyoglossus enlargements were common in the early period in both groups, but all cases became atrophic later.MRI can differentiate LRFs from FFs in a variety of parameters after flap reconstructive surgery for tongue cancer.

In an era where the incidence of oropharyngeal cancer is growing steadily, there have been few studies exploring functional outcomes for individuals whose definitive cancer management approach includes transoral robotic surgical (TORS) resection. This study was designed to examine swallow-related outcomes in individuals newly diagnosed with base of tongue cancer whose treatment plan included surgical resection via TORS. The aims of this study were to determine whether TORS resection for early stage BOT SCCA affected: (a) lingual strength, (b) swallow safety and efficiency, (c) oral intake, and (d) swallowing-related quality of life. Nine individuals meeting the inclusion criteria were recruited to participate from March 2017 to April 2018. Each participant was evaluated at four distinct time points: (a) preoperatively, (b) 1 week postoperatively, (c) 1 month postoperatively, and (d) 3 months postoperatively. The following data were collected at each time point: (a) maximum isometric lingual pressure, (b) Penetration-Aspiration Scale score, (c) Yale Pharyngeal Residue Severity Rating Scale scores, (d) Functional Oral Intake Scale score, and (e) EAT-10 score. Data analysis revealed that a significant decline in maximum isometric lingual pressure, EAT-10 scores, and Functional Oral Intake Scale scores occurred between preoperative baseline measurements and 1 week post surgery. All participants in the study demonstrated a return to levels at or near their baseline level of function for maximum isometric lingual pressure, EAT-10 score, and Functional Oral Intake Scale score by 1 or 3 months post surgery. There were no significant changes in swallow safety or efficiency observed at any time point during the study.

Background: Carcinoma of oral tongue has a great potential for metastatic spread to neck nodes, which may not be clinically detected in early stage. To detect frequency of occult neck metastasis in clinically No patients with early oral tongue carcinoma (stage I & II) the study has done. Methods: It was a 2 years cross sectional study among fifty patients in three tertiary care hospitals of Dhaka from 2016 to 2018. Results: Majority of the patients were male (M:F=3:2) with age ranged 25 to 80 years. Among these patients 38(76%) were in T1 and remaining 12(24%) in T2 stage. Tongue ulceration was most common(84%) presenting feature followed by dysphagia(64%) and pain(52%).Only 32(64%) patients revealed no histopathological proved metastasis(true N0). Occult nodal metastasis was significantly common(83.33%) among male patients than females(p

OBJECTIVE The aim of this study was to evaluate the diagnostic performance of contrast-enhanced F-18 fluoro-2-deoxyglucose (F-18 FDG) PET/computed tomography (CT) in restaging of tongue carcinoma. MATERIAL AND METHODS Retrospectively analysis of carcinoma tongue patients (n = 110) who were treated and referred for FDG PET/CT. Histopathological examination and clinical or imaging follow-up were taken as gold standard. RESULTS Of 110 patients, FDG PET/CT detected FDG avid lesions in 69 (62.7%) patients. Sensitivity, specificity and diagnostic accuracy of FDG PET/CT were 92.9%, 90.0% and 91.8%, respectively, for residual/recurrence disease detection (P < 0.05). Additionally, in six patients, metachronous primaries were also detected [lung (4), esophagus and lymphoma (1) each]. The mean maximum standardized uptake value (SUVmax) with 95% confidence interval for primary site recurrence, regional lymph nodes and metastatic lesions was 11.51 (9.53-13.48), 69 (62.7%) (7.88-11.48) and 8.94 (3.11-14.76), respectively. CONCLUSION FDG PET/CT demonstrates high diagnostic accuracy for detection of residual/recurrent disease in treated tongue cancer patients and PET/CT should be considered as first-line diagnostic investigation in these patients.

The aim of this study was to identify patterns of tumor growth as revealed on magnetic resonance imaging (MRI) and to evaluate the correlation of these patterns with histopathologic features and rates of recurrence, disease-free survival (DFS), and overall survival (OS).In a retrospective analysis of patients with tongue carcinoma, tumor advancing margins, patterns of tumor enhancement, and enhancement beyond tumor margins were studied on MRI. Histopathologic findings included differentiation, margin status, perineural invasion (PNI), and lymphovascular invasion (LVI). MRI and histopathologic features were correlated with outcomes.Ill-defined tumor margins and enhancement beyond tumor margins were associated with recurrences (P ≤ .001) regardless of perineural invasion or LVI. DFS and OS were adversely affected by ill-defined tumor margins (P ≤ .010). DFS was also affected by enhancement beyond the tumor margins (P.001). A heterogeneous pattern of enhancement showed a trend toward a decrease in DFS and OS (P = .088 and .092, respectively). Advancing tumor margins on MRI were independent predictors of overall survival. MRI characteristics exhibited significant associations with histopathologic margins, PNI, and LVI.Ill-defined advancing tumor margins, a heterogeneous pattern of enhancement, and enhancement beyond the tumor margins on MRI adversely affect outcomes and prognosis in tongue carcinoma.

Objective The purpose of our systematic review was to investigate the prevalence of level IV involvement and skip metastases in patients with clinically negative neck (cN0) oral tongue squamous cell carcinoma (OTSCC). The occurrence of occult metastases to lower levels in the neck (levels IV and V) or the development of an erratic distribution of cervical metastases (“skip metastases”) that bypass the upper neck levels (levels I to III) and go directly to level IV or V challenges the role of supraomohyoid neck dissection in the treatment of OTSCC; therefore, controversy exists over including level IV cervical nodes during an elective neck dissection of OTSCC. Study Design Our search included all studies published from 1989 until January 2018 in the Cochrane Library, PubMed, EMBASE, and Web of Science. Abstracts and full-text articles that were deemed potentially relevant were screened. Data from the studies were extracted by using standardized tables, and a meta-analysis was conducted. Results In total, 3000 abstracts and 269 full text articles were screened, and 11 studies were included in this analysis. Among the 498 patients included, 16 had level IV involvement, representing involvement of 2.8%. The incidence for skip metastasis to level IV was low as well. Conclusions We recommend elective neck dissection that includes levels I to III in selected patients with OTSCC and cN0 neck.

Background: Tongue carcinoma is characterized by high recurrence rate. Thus, post-treatment follow-up imaging is critically important. Advanced Magnetic Resonance Imaging (MRI) techniques can be employed for this purpose due to the limited accuracy of conventional MRI. Aim of Study: Evaluation of the value of Diffusion Weight-ed (DW) and perfusion weighted MRI implementation in the post-treatment follow-up of tongue carcinoma. Patients and Methods: This study was conducted on 23 patients on post-treatment follow-up of tongue carcinoma. They underwent DW-MRI and Dynamic Contrast Enhanced (DCE) perfusion T1-weighted MRI to differentiate between recurrent tumor and post-treatment changes. Apparent Diffu-sion Coefficient (ADC) was estimated, perfusion MR quali-tative and semiquantitative assessment was performed. Re-sulting data were compared to histopathologic characterization (n=18) and further clinical and radiological follow-up (n=5) which were considered as the reference standards. Results: The mean ADC value of recurrent tongue carci-noma (1.029±0.207 X 10–3mm2/s) was significantly lower (p < 0.001) than the mean ADC value of post-treatment changes (1.425±0.238 X 10–3mm2/s). The ADC threshold used for differentiating recurrent tumor from post-treatment changes was 1.175 X 10–3mm2/s with Area Under the Curve (AUC) of 0.938 and diagnostic accuracy of 82.6%. Among the DCE perfusion weighted MR parameters, the wash in rate and Area Under Gadolinium Curve (AUGC) displayed the highest diagnostic accuracy (73.9%) with thresholds of 18.65a.u/s and 126826.7m.M.s respectively. The combined use of both DW-MRI and perfusion weighted MRI showed the highest diagnostic accuracy. Conclusion: The DW MRI is a non-invasive technique providing accurate post-treatment follow-up assessment of tongue carcinoma. The perfusion weighted MRI provides lower diagnostic accuracy than DWI. The combined use of both techniques provides superior differentiation of tumor recurrence from post-treatment changes.

Hyperthermia may be effective for cases of oral squamous cell carcinoma (OSCC) or lymph node metastasis that cannot be otherwise treated. In our hospital, we perform hyperthermia by microwave interstitial heating. The cases of two patients with lymph node metastasis following surgery for OSCC in whom complete response was achieved with this method are presented. Case 1 was a 55-year-old man with right tongue carcinoma (T2N2cM0) who had undergone preoperative chemotherapy followed by radical surgery. Metastasis was subsequently identified in a right lingual lymph node, and surgery was planned, but since the patient did not consent, he was instead treated with chemoradiotherapy. However, since he did not respond sufficiently to this treatment, in the absence of any other alternative, two sessions of hyperthermia alone were administered. The results were good, and 10 years after treatment, there has been no further sign of metastasis or recurrence. Case 2 was a 69-year-old woman who had undergone resection of a carcinoma of the oral floor (T2N0M0). Four months later, metastasis was identified in a right cervical lymph node, and neck dissection was planned, but since the patient did not consent, she was instead treated with chemoradiotherapy. However, she did not respond to this treatment, and the metastatic lesion enlarged, so hyperthermia was performed. Her post-treatment course was uneventful, and five years later there has been no sign of recurrence. Hyperthermia may be an effective means of treatment in patients for whom it is indicated.

Nasolabial flaps are widely used in reconstruction of orofacial structures using trans-buccal tunnel in two stages. Inferiorly based islanded nasolabial flaps can be harvested with meticulous skeletonization of facial vessels proximal to flap and transferred behind mandible through mylohyoid tunnel. This variation in technique of harvest and transfer increases the flap distal reach, avoids restriction in tongue mobility and allows single-stage tongue reconstruction. We present a series of operated patients of early lesions of tongue carcinoma with this newer technical modification and their functional outcome. This study included biopsy proven 8 patients diagnosed with early stage (T2, T3) carcinoma tongue. Single-stage islanded nasolabial flaps based on facial artery and vein were harvested and tunnelled behind mandible onto the tongue defect. Follow up of all patients was recorded with respect to speech, deglutition and tongue mobility. All operated patients had good functional outcome in terms of swallowing, speech and tongue mobility. All patients were satisfactory with the postoperative results. In comparison to microvascular reconstruction, this option justifies a reliable and a cost-effective approach especially in co-morbid patients.

OBJECTIVES/HYPOTHESIS For early-stage oral tongue carcinoma and carcinoma in situ (ESOTCCIS), we evaluated patient-reported quality-of-life (QOL) outcomes following resection with primary closure (R-PC). STUDY DESIGN Retrospective review at an academic cancer center. METHODS Thirty-nine ESOTCCIS patients (Tis, T1, T2) who underwent R-PC without radiation completed the University of Washington Quality of Life Questionnaire Version 4 (UW-QOL) at least 6 months since R-PC (mean = 2.39 years; range = 0.5-6.7 years). We compared UW-QOL scores for pain, swallowing, chewing, speech, and taste to established normative population scores. Multivariable regression analysis evaluated factors associated with QOL impairment. RESULTS ESOTCCIS patients who underwent R-PC in comparison to the normative population reported significantly worse mean speech (87.7 vs. 98, P

Background Ezrin, ERK, STAT3, and AKT are proteins that are overexpressed in various types of cancer, although their expressions in tongue cancer has received less focus. This study aimed to address associations between the expression levels of these proteins and with characteristics of the tumor and patient survival. Methods We performed immunohistochemical staining of ezrin, ERK, STAT3, and AKT in tumors from patients with tongue carcinoma in situ (CIS, n = 17) and tongue squamous cell carcinoma (SCC, n = 46). Statistical differences between the SCC versus the CIS cohorts were estimated by calculations of bivariate odds ratios of low versus high expression of the proteins. Fisher's exact tests were used to appraise interassociations between the proteins, as well as expression levels versus patient and tumor characteristics. Survival based on Kaplan–Meier statistics in combination log‐rank tests were used to address potential effects of the patient and tumor characteristics versus 5‐year survival rate. Results The relative high: low expression of all four proteins in the two cohorts differed, and particularly ERK was markedly overexpressed in the SCC versus the CIS cohort (odds ratio = 45.3, p

Historically considered a disease of the older male resulting from cumulative tobacco and alcohol use, more recently we have witnessed a rise in the global incidence of oral tongue squamous cell carcinoma in younger adults, particularly those without any identifiable risk factor exposure. These patients appear to be at higher overall risk for locoregional treatment failure and often experience a more heterogeneous clinical course, with some afflicted with particularly aggressive, rapidly progressive disease. Recent research efforts have supported the idea that although this disease may be genomically similar in these groups, and molecular differences in the tumor immune microenvironment may account for biological differences between young and older patients, as well as patients with and without exposure to alcohol or tobacco. In this review, we seek to summarize current knowledge regarding pathogenesis of oral tongue carcinoma in the young adult patient and examine the potential role of the immune response in disease progression and as a target for novel immunotherapies.

Study Background: Depth of invasion, although being considered as an independent risk factor for occult lymph node metastasis in oral cavity cancers, is very difficult to obtain by frozen section or incisional biopsy, making neck dissection compulsory for its’ determination. Hence, in this study, we are trying to set a pre-operative radiological cut-off through which we can prevent or limit un-necessary neck dissections and thus, reduce the associated co-morbidities. Aims: 1) To know whether the increase in the depth of invasion in oral cavity carcinoma assessed histopathologically and radiologically co-relates with neck node metastasis. 2) To accurately co-relate the radiological thickness at which neck dissection is required. Methodology: A retrospective study has been conducted over thirty patients with oral cavity carcinoma (buccal mucosa and anterior two-thirds of the tongue) in the time period of April 2018 to December 2018 who were operated in our tertiary care hospital. Results: Depth of invasion is relatable histopathologically and radiologically and is directly proportional to neck node metastasis. Pre-operative radiology is a reliable modality to rule out the need of neck node dissection. Conclusions: Depth of invasion is directly proportional to the incidence of neck node metastasis and pre-operative radiology has been reliable to rule out the need of neck dissection and reduce its morbidity.

Laryngeal and tongue squamous cell carcinomas account for an estimated 37,000 cases and 7,000 deaths/year in the U.S. The localized lesions are generally treated by surgical resection, and/or radiation therapy. When progression to metastases occurs, a systemic chemotherapy is necessary. An efficacious medication has not been available; largely due to the absence of information regarding the development and progression of those malignancies. Consequently, potential targets for successful chemotherapy are not identified. Since decreased zinc has been implicated in the development and treatment of all other carcinomas, it likely exists in laryngeal and tongue squamous cell carcinomas. This report demonstrates that zinc is decreased in these malignancies when compared to the normal cells; and is likely due to the downregulation of their functional ZIP-family zinc-uptake transporter. The reason is that the higher zinc level in the normal cells is cytotoxic in the malignant cells. Therefore, a chemotherapy that restores the higher zinc levels will be cytotoxic in the malignant cells. To achieve this, we employed clioquinol zinc ionophore to facilitate the uptake and accumulation of zinc. The treatment inhibited proliferation of HN4 laryngeal carcinoma cells and HN6 tongue carcinoma cells. That is consistent with other reports that collectively demonstrate that all carcinomas are “ZIP-deficient/decreased zinc” malignancies; and can be terminated by a treatment, such as clioquinol, to facilitate the uptake of cytotoxic levels of zinc. It is now necessary to establish the efficacy of the clioquinol treatment for human laryngeal and tongue tumors under in vivo conditions in xenograft implants in animals; and ultimately in human clinical trials. A case report of the first successful treatment of a patient with terminal advanced prostate carcinoma had included clioquinol. It is reasonable to expect that clioquinol treatment could be the first chemotherapy for terminating tongue and laryngeal squamous cell carcinomas.

Squamous cell carcinoma (SCC) of the tongue typically affects individuals over 50 year of age, is relatively rare in patients who are less than 40, and occurs most often on the lateral borders. SCC of the dorsum of the tongue is relatively rare and reported to comprise only 2.9%–7.2% of all cases, and SCC in the midline of the tongue dorsum accounts for less than 1% of tongue carcinoma. We report an exceedingly rare case of SCC of the tongue arising in the midline of the dorsum in a 33-year-old man and review the literature. The patient was referred by a primary care physician and visited our hospital with a chief complaint of a mass in the midline of the tongue dorsum. Intraoral examination revealed a mass with a diameter of 14 × 13 mm anterior to the vallate papillae in the midline of the dorsum of the tongue. The mass was ellipse, well-circumscribed and elastic hard with no surrounding induration. There was no palpable enlarged lymph in the submandibular and cervical region. An incision biopsy was performed under local anesthesia. The pathological diagnosis was well-differentiated SCC. Based on a clinical diagnosis of tongue carcinoma T1N0M0, a partial glossectomy setting 10 mm or more safety margin around the tumor was performed under general anesthesia in June 2015. The postoperative course was uneventful, therefore, the patient was discharged on the 10th postoperative day. During follow-up for 3 years, there has been no dysfunction such as dysphagia and dysarthria, and no sign of recurrence or metastasis.

Tongue squamous cell carcinoma (TSCC) generally affects the older age group exposed to tobacco for an extended period. However, recent research points out that there is an increased incidence of TSCC in the younger age group without any traditional risk factors making TSCC as a distinct biological entity in this group. This study aims to assess the prevalence and risk factors of tongue carcinoma in the younger group of patients. This article included studies that addressed the TSCC involving young patients and that which are PubMed indexed. Initially, 390 articles were considered; but after refined evaluation, 123 articles had their titles and abstracts matching to this present work. After the extraction of the case reports, review articles and the articles without the assessment of the parameter of harmful habits, we have included only 23 articles in the sample matching the title. The statistical analysis was formed by using chi-square tests using IBM SPSS ver. 20.0. The cohort of the younger population in these studies was mostly in the 35- to the 45-year age group. The majority of reports (64%) classified the patients below 40 years of age as a young group. Though male predominance is reported to be 55%, female patients are also more affected (40%) in the younger age group compared with, the more typical and usual group of head and neck carcinoma patients. TSCC in older adults predominantly reported in tobacco users (70%) whereas in young adults, TSCC was associated with a higher incidence in nonsmokers (53%); the causes of these cancers in young adults remain unclear. The identification of the potential risk factors aside from traditional factors is vital to control the incidence of TSCC in young patients.

Introduction: th In tongue carcinoma according to AJCC 8 guidelines depth of invasion is included in staging, therefore there is need of imaging which can accurately assess the pretreatment stage of tumor. The objective of this study was to correlate the depth of invasion reporting by MRI and postoperative HPR. Methods: In MRI DOI was measured by drawing perpendicular lines from the reference line to the point of maximal tumor projection in the tongue medially, histologically DOI was measured from the level of the basement membrane of the closest adjacent normal mucosa. Results: Paired t test was done on the DOI of MRI and HPR. The two tailed P value is less than 0.0001. This difference is considered to be extremely statistically signicant. The mean of group one (DOI-MRI) minus Group 2 (DOI-HPR) equals 6.860. 95% condence interval of this difference is from 5.200 to 8.520. Conclusion: In our study we nd there is statiscally signicant difference between DOI reports in MRI and postoperative HPR.

The role of electrochemotherapy (ECT) using intratumoral bleomycin and electroporation as a first line treatment for oral tongue carcinoma has not been defined.To evaluate the method of ECT in oral tongue carcinoma.Twenty-one successive patients with primary T1-T2 oral cancer predominantly of the oral tongue underwent either ECT (test;The 10-year local recurrence rate (44.4%) was higher and the tumour-specific survival rate (55.6%) was lower in the ECT group compared to the control group (17% and 91.6%, respectively). Postoperative haemorrhage, dysphagia, and pain were more frequent in ECT patients, treatment time was shorter, but treatment cost was higher. Quality of life was not improved by ECT.Our results indicate that ECT seems not as suitable for the treatment of early tongue cancer as it is for neoplastic and metastatic skin lesions and less favourable than standard surgical therapy.

Background: To evaluate the diagnostic performance of [ 18 F]fluorodeoxyglucose positron emission tomography/computed tomography ([ 18 F]FDG-PET/CT) scan in detecting local recurrences in patients with surgically treated oral tongue squamous cell cancer (OTSCC). Material and methods: Eighty-seven patients who had undergone surgery for OTSCC were monitored clinically and [ 18 F]FDGPET/CT and magnetic resonance (MR). PET uptakes were classified as functional (Type A), suspicious (Type B), or highly suggestive of local recurrence (Type C). A multidisciplinary team (MDT) evaluated case-by-case the surveillance strategy based on PET uptake. Results: Fifty-nine patients presented FDG-PET uptake during follow-up: this report was significantly more frequent in patients who received flap reconstruction than in those without (73% vs 50%; p = 0.05). In 13 patients with Type A (n = 1), Type B (n = 9), and Type C (n = 3) uptakes an additional MR was considered preferable and discovered recurrence in 12.PET-CT had 9 true positives, 17 false positives, 71 true negatives, and no false-negative, resulting in sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of 100%, 80.7%, 34.6%, and 100%. Conclusions: The present results demonstrated a change in diagnostic strategy, as decided by the MDT, in about one-fifth of patients. The results should prompt in designing a rational surveillance schedule in surgically treated OTSCC.

With the progress of surgical technology, the survival rate after resection of esophageal and tongue carcinomas has improved. However, the surgical protocol for esophageal and tongue surgery is complex, and surgery for elderly esophageal and tongue carcinoma patients with cardiopulmonary dysfunction is difficult. Using an artificial tongue and esophagus will be helpful for patients. However, peristalsis of foods depends on food size, taste, and viscosity. This study developed and evaluated a new diagnosis machine for drinking and peristalsis motion. Before clinical evaluation, animal experiments were performed on healthy adult goats using a stereo camera. After a feasibility study of the diagnosis system for peristalsis, clinical evaluation was conducted on healthy normal volunteers. We observed no aspiration pneumonia. The foods and drinks tested were safe. There was no mis-swallowing, but the participants’ feeling with regard to taste differed. Overall, the results indicated that the quantitative swallowing and peristalsis diagnosis system is safe. Evaluation of the visual imaging and spectral analysis gave us useful information about peristalsis, which will help us design an artificial tongue and esophagus with a good control mechanism in the near future.

To analyze the factors predicting survival outcomes in treatment naive oral tongue squamous cell carcinoma (OTSCC). A comprehensive review of 531 oral tongue carcinoma patients treated with upfront surgery followed by adjuvant radiotherapy or chemoradiotherapy was conducted from 2004–2018. The mean age of presentation was 53 years (11–86) with a male to female ratio of 1.3:1. The associated risk factors were smoking (21%), betel nut (16%), naswar (9%) and alcohol (1%). Most of the cases were either well (45.1%) or moderately (46.2%) differentiated. Surgery was performed in 164 patients alone while 368 were treated with surgery in combination with adjuvant modalities. Overall (OS) and disease free survival (DFS) were 66 and 71%, respectively, with a median follow up of 2.5 years. Cox regression analysis showed nodal positivity, increased depth of invasion (DOI) and higher lymph node ratio (LNR) as significant prognosticators impacting OS and DSS. Nodal volume, DOI and LNR are the most consistent predictors of poor outcome in OTSCC. Nodal positivity, depth of invasion > 5 mm and lymph node ratio > 0.04 adversely affect OS and DSS.

Aims & Objectives: To study various reconstructive options in oral cavity cancer surgeries at our centre. Material and Methods: The present prospective study was conducted in the Department of ENT, GMC Jammu from January 2018 to December 2019 on 20 diagnosed cases of head and neck malignancy, who underwent reconstruction options such as local flap, pedicled flap or free flap. Results: Out of 11 lip cancer patients, 1 had local flap repair, rest all underwent primary closure. Out of 7 tongue carcinoma patients, 2 underwent free flap repair while 5 had primary closure. Out of 2 buccal carcinoma patients, one underwent excision with split thickness skin graft repair and 1 had pedicled flap repair. All reconstructions were having successful functional outcome at 6 months after surgery. Conclusion: From our study we can conclude that if performed with utmost care, the functional outcomes of various modes of reconstruction in oral cavity cancer surgeries from simple primary closure to complex ones like pedicled or free flaps, can be satisfactory.

Squamous Cell Carcinoma (SCC) of the tongue is the most widely recognised malignant neoplasm, representing 25 to 50% of all oral malignancies. In recent years, brachytherapy has been used in management of neoplasms of the head and neck region. This clinical report illustrates a method of customised mould fabrication for a 48-year-old patient diagnosed with SCC of lateral border of tongue undergoing brachytherapy treatment and emphasises the responsibility of a maxillofacial prosthodontist in designing a non-invasive prosthesis which maintains the radiotherapy catheters in the required predetermined position as per the requirement of the radiologist.

Aims To evaluate patterns of locoregional recurrence following adjuvant (chemo)radiotherapy for oral cavity squamous cell carcinomas. Materials and methods One hundred and one patients who received adjuvant radiotherapy ± chemotherapy for oral cavity squamous cell carcinoma between 2013 and 2016 were analysed. For documented locoregional recurrence, recurrence imaging was deformably co-registered to the planning computed tomography scan. The volume of recurrence was delineated (Vrec). Vrec coverage by 95% of the corresponding planning target volume prescription dose was determined and the location compared with planning target volumes. Sites of recurrence were classified using a combined volume and centroid-based method: (A) central high dose, (B) peripheral high dose, (C) central low dose, (D) central peripheral dose, (E) extraneous. Results The median follow-up was 36 months. Forty-three per cent and 53% of patients received radiotherapy to the ipsilateral neck only and bilateral neck, respectively. Three-year overall survival, disease-free survival, local control, regional control and distant metastases-free survival were 63.0, 65.6, 88.0, 85.1 and 85.3%, respectively. Of 10 episodes of primary site recurrences, five were type A, four type B and one was type E. Of 14 episodes of regional recurrence, five were type A, two type C, two type D and five type E. Five of 21 (24%) patients with oral tongue carcinoma with an undissected/unirradiated contralateral neck had a type E contralateral neck recurrence, including 2/11 with pN0, 1/4 with pN1 and 2/6 with pN2 disease. Conclusions Marginal and out-of-field recurrences remain a significant pattern of failure. We advocate generous target delineation postoperatively and, for oral tongue carcinomas, a comprehensive approach with bilateral neck irradiation.

MOB1 deficiency promotes rapid onset and progression of oral SCC (OSCC) via YAP1 activation., Head-and-neck squamous cell carcinoma (HNSCC) is the sixth most common group of cancers in the world, and patients have a poor prognosis. Here, we present data indicating that YAP1 may be a strong driver of the onset and progression of oral SCC (OSCC), a major subtype of HNSCC. Mice with tongue-specific deletion of Mob1a/b and thus endogenous YAP1 hyperactivation underwent surprisingly rapid and highly reproducible tumorigenesis, developing tongue carcinoma in situ within 2 weeks and invasive SCC within 4 weeks. In humans, precancerous tongue dysplasia displays YAP1 activation correlating with reduced patient survival. Combinations of molecules mutated in OSCC may increase and sustain YAP1 activation to the point of oncogenicity. Strikingly, siRNA or pharmacological inhibition of YAP1 blocks murine OSCC onset in vitro and in vivo. Our work justifies targeting YAP1 as therapy for OSCC and perhaps HNSCC, and our mouse model represents a powerful tool for evaluating these agents.

Oral positioning radiotherapy stents are devices that protect healthy structures adjacent to the target volume of head and neck radiotherapy treatment, leading to reduced acute and chronic side effects. This study describes a digital workflow to produce an oral positioning radiotherapy stent and analyze its efficacy by measuring dosimetric variations with and without this stent. An oral positioning radiotherapy stent was created according to a digital workflow that included intraoral scanning, digital design, and 3D printing for a patient with squamous cell carcinoma of the tongue. The patient underwent computed tomography to evaluate radiotherapy treatment by intensity-modulated radiation therapy with and without the use of the 3D-printed oral stent. The use of a 3D-printed oral positioning radiotherapy stent is a feasible and reproducible technique that reduced the planning target volume and radiation doses delivered to the hard palate, right parotid gland, and left parotid gland by 42%, 21%, and 8.5%, respectively.

Primary intestinal-type adenocarcinoma (ITAC) of the tongue is a rare neoplasm. The case of a 59-year-old male with a painless mass in the dorsum of the oral tongue diagnosed as primary ITAC is reported here. The particular characteristic of the case was the patient's long-term medical history of 40years. The patient underwent resection of the tongue carcinoma through a midline approach and direct suture, with postoperative chemoradiotherapy. Immunohistochemical staining indicated that the tumour was positive for CK20 and negative for CK7. A review of the English-language literature was performed, which identified six cases of primary ITAC and three cases of metastatic ITAC of the tongue. The clinical characteristics and therapeutic methods used in these cases were analysed.

Objective Depth of invasion (DOI) in oral carcinoma has been integrated into the primary tumor categories in the current tumor-node-metastasis staging (8th edition). However, there is no standard modality to determine DOI preoperatively. The aims of the present study were to evaluate the accuracy of a preoperative measurement of DOI using ultrasonography (US) for superficial oral tongue carcinomas, and to correlate the values obtained with histologically determined DOI measurements. Methods We retrospectively analyzed the records of 56 patients with oral tongue carcinoma who underwent intraoral US preoperatively, followed by curative surgery at the Shizuoka Cancer Center Hospital in Japan. For the measurement of DOI with US, our unique technique (water balloon method) was evaluated. Results The histologically measured tumor size (maximum diameter) showed a distribution of 7.0 to 40.0 mm (mean, 18.6 mm). The correlation between the US-obtained and histologically obtained DOIs was significant (r = 0.867; P 5 mm were 92.3% and 70.6%, respectively. Conclusion Intraoral US provides sufficient accuracy for the measurement of tumor DOI in oral tongue carcinoma and is complementary in assessing superficial lesions. Level of evidence 4. Laryngoscope, 128:2778-2782, 2018.

To identify the difference of surgical margin and recurrence status of early stage tongue carcinoma via wide excision in a single institution with and without free flap reconstruction.Survey whether the reconstruction methods for early tongue cancer affects disease control, survival outcomes.This was a retrospective study and patients with early tongue cancer underwent surgery via tumor ablation with (group 1 = 56) or without free flap reconstruction (group 2 = 291).The percentage of patients with free margin less than 5 mm was higher in the group 2 than in group 1 (49.48% vs. 19.64%, p .001), as the mean free margin was significantly larger in group 1 than in group 2 (7.88 mm vs. 5.68 mm; p .001). Despite higher number of T2 stage patients in group 1 (89.29%), the group 1 resulted in a significant lower recurrence rate (p = .024).The utilization of free flap reconstruction for early stage tongue cancer achieved a large pathologic free margin and had relative lower recurrence and good survival rates.

Objectives/hypothesis Adequate surgical resection of early stage oral tongue cancer provides the best chance at preventing locoregional disease recurrence. Determination of tumor dimensions and margin location is challenging and can lead to inadequate resections with close/positive margins. Ultrasonography has proven its utility in determining the thickness and extent of tongue tumors. Preoperative tumor dimension measurements carry increased significance with the addition of depth of invasion (DOI) to the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system. We report the results of a systematic review of the literature pertaining to the use of ultrasound in the diagnosis and management of oral tongue carcinoma. Methods The Preferred Reporting Items for Systematic Reviews and Meta-analysis statement checklist was used to inform the design of this systematic review. All studies that utilized ultrasound in the diagnosis/management of primary carcinoma of the oral tongue were included. PubMed, Embase, and Cochrane were reviewed to identify eligible studies. Results Nineteen articles were included in our analysis. Six hundred seventy-eight patients were studied in the articles included. Ultrasound tumor thickness measurements correlate well with those on histopathology and show promise as a predictor of cervical lymph node metastasis. Ultrasound can be safely used intraoperatively for deep margin assessment. Conclusions Ultrasound is useful in the evaluation of oral tongue malignancies. More experience is needed to determine if it is reliable in determining preoperative DOI in light of the role this tumor parameter plays in the eighth edition of the AJCC staging manual. Laryngoscope, 129:662-670, 2019.