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Purpose: Tongue edema is a potential cause of treatment target underdosage in high-dose-rate interstitial brachytherapy (HDR-ISBT) of mobile tongue cancer. To prevent such edema-associated alteration of dosimetry, we developed a special silicon device. In this report we communicate our initial experience with two mobile tongue cancer patients whom we treated using this new device. Material and methods: The device consists of silicone tubes with a fixed width and scalable length depending on tongue size. These tubes are lined and fixed like a palisade, allowing the device to be used also as a template. The device is placed next to the lateral border of the tongue and on the floor of the mouth. In addition, a vinyl template can be placed on the dorsal tongue surface with both devices combined for implantation guidance. Between June and August 2012, two patients with locally confined tongue cancer were treated. Results: Between June and August 2012, two mobile tongue cancer patients classified as cT2N0M0 were treated with HDR-ISBT using the silicone device. They underwent ISBT as monotherapy with fractional doses of 6.0 Gy up to a total physical dose of 54.0 Gy. The D90 (CTV) values of both patients were 6.3 Gy and 6.6 Gy and the D2cc (mandible) values were 3.4 Gy and 2.6 Gy, respectively. At present, both patients remain without local disease recurrence at 60 and 56 months after ISBT, respectively. Conclusions: The described silicone device has the potential to prevent underdosage to the treatment target related to tongue edema. It has been shown to be safe and easy to implement.

With the development of the Internet and the popularity of the intelligent devices, the research on mobile tongue diagnosis in traditional Chinese medicine is deepening. This paper mainly introduces four relative critical technologies, namely acquisition, color correction, segmentation and feature processing of tongue images. At the same time, the research progress of relevant technologies in recent years is summarized to provide reference for further study on mobile tongue diagnosis platform of TCM(Traditional Chinese Medicine).

The objective of this study was to evaluate the immunoexpression profiles of breast cancer 1 (BRCA1) and acetyl-histone H3 (AcH3) in squamous cell carcinoma of the mobile tongue (SCC-MT) and their correlation with epidemiologic data and the histopathological grade of tumors.Incisional biopsies of 43 SCC-MT were submitted to immunohistochemistry for AcH3 and BRCA1. Samples were microscopically graded as well differentiated (n = 21) or poorly differentiated (n = 22). Both groups were submitted to statistical analysis (P.05) regarding the percentage of positive cells.Thirty-nine cases were positive for AcH3 (91%), but no difference was observed for the histologic grading (P = .27). Positivity for BRCA1 was observed in all samples regardless of their cellular locations. Most cases in the poorly differentiated group presented with less than 10% nuclear staining (P.01) and a predominance of cytoplasmic staining (P = .034). The well-differentiated group showed nuclear staining in most of the cases, with more than 50% of cells staining positive (P.01).AcH3 and BRCA1 were expressed in all samples. There was a significant decrease in cytoplasmic BRCA1 expression in the poorly differentiated group, suggesting BRCA1 as a possible prognostic marker for SCC-MT.

The pectoralis major flap (PMF) is one of the most used pedicled flaps for reconstructive surgery in head and neck. Basing on previous studies observing that a vascular accident or pedicle ligation not always resulted in necrosis of free flaps, sometimes after a short critical period, we describe the possibility to perform the division of the PMF pedicle. The autonomization of PMF is based on the hypothesis that the flap, after a critical period, develops a neoangiogenesis at the free portion in the recipient site. It represents a possible choice in selected patients with relapse or second tumour of the oral floor and/or mobile tongue, who have been already treated with PMF reconstruction. We provide a step-by-step description of the autonomization and use of the modified PMF. Moreover, we reported advantages and pitfalls. The modified PMF represents a safe reconstructive choice for patients advised against a free flap or a second pedicled flap, with good surgical outcomes.

Cancers of the tongue are the most common cancers of the oral cavity with poor survival [1,2]. The main risk factors are...

A case of a 12-month-old male infant, who presented a painless swelling of the right anterolateral edge of the mobile tongue, is reported. The treatment consisted of a partial glossectomy with total surgical excision of the tumor. The diagnosis of low grade myofibroblastic sarcoma on the histological arguments (tumor architecture, cytology, mitotic index) and immunohistochemistry was retained.

The objectives were to determine the prevalence of human papillomavirus (HPV) in mobile tongue cancer (MTC) and evaluate associations and survival.Patients who underwent surgical resection as primary treatment for MTC (n = 127) were retrospectively evaluated. Formalin-fixed paraffin-embedded (FFPE) specimens were assessed for p16 and p53 by immunohistochemistry; for HPV DNA by nested multiplex polymerase chain reaction (PCR) using two pairs of consensus primers (MY09-MY11 and GP5+-GP6+); and for E6 and E7 oncogenes from 13 high-risk HPV types (16, 18, 31, 33, 35, 39, 45, 52, 56, 58, 59, 66, and 68) by real-time reverse transcription PCR (RT-PCR).There were 18 (14.2%) p16-positive, 45 (35.4%) p53-positive, 9 (7.1%) HPV DNA-positive, and 7 (5.5%) E6 and/or E7 mRNA-positive tumors, but the correlation of all pairs was poor. There was no demographic or histopathologic association with HPV status. Cause-specific survival was significantly better with p16-positive than with p16-negative tumors (p = .037).The prevalence of HPV and p16 positivity was relatively low and p16 status was a poor surrogate marker for HPV status. The results showed the importance of p16 expression in prognosticating mobile tongue cancer.

The focal adhesion kinase (FAK)/SRC phosphorylation cascade and its downstream target paxillin have been implicated in malignant transformation, tumor growth and progression, together with metastasis. The present study aimed to evaluate the clinical significance of concomitant FAK/SRC and p-paxillin expression in mobile tongue squamous cell carcinoma (SCC).FAK, SRC and phospho-paxillin expression in 48 mobile tongue SCC tissue samples was assessed immunohistochemically and analyzed with respect to clinicopathological characteristics and patient survival.Concomitant high FAK/SRC expression was significantly associated with high grade of tumor differentiation (p=0.048) and longer disease-free patient survival (log-rank test, p=0.019). High p-paxillin expression was significantly associated with greater depth of invasion (p=0.002), lymph node metastasis (p=0.048) and poorer disease-free patient survival (log-rank test, p=0.021; Cox-regression analysis, p=0.031).The present study provides evidence that FAK/SRC and paxillin play a role in the pathophysiological aspects of mobile tongue SCC and could constitute therapeutic targets.

The 4th edition of the World Health Organization’s Classification of Head and Neck Tumours was published in January of 2017. This article provides a summary of the changes to Chapter 4 Tumours of the oral cavity and mobile tongue and Chapter 8 Odontogenic and maxillofacial bone tumours. Odontogenic cysts which were eliminated from the 3rd 2005 edition were included in the 4th edition as well as other unique allied conditons of the jaws. Many new tumors published since 2005 have been included in the 2017 classification.

Human keratin 36 (K36) is a member of the hair keratin family and is a marker of hair cortex differentiation. The human KRT36 gene is located on the long arm of chromosome 17 and belongs to the cluster of structurally unrelated acidic hair keratins. Recently, it has been reported that KRT36 mRNA is specifically expressed in normal tongue epithelium and downregulated in squamous cell carcinomas of the mobile tongue. Furthermore, KRT36 levels have been reported to be downregulated in clinically normal mobile tongue tissue that is adjacent to tumours, suggesting it could be a marker of pre-neoplastic changes. However, the exact role and the potential role of K36 in tongue tumour formation remains unclear. The aim of the present study was to investigate expression of K36 in a series of squamous cell carcinomas of the mobile tongue, normal mobile tongue and a small panel of other human tissues (normal tissue from the appendix, cervix, hair, lip, mamilla, nail, oesophagus, skin, thymus and vagina) and selected cancer tissue (cervical cancer, melanoma and basal cell carcinoma). Affinity purified polyclonal antibodies against K36 were generated and used for immunohistochemical analysis. The results revealed that in the normal tongue, K36 was detected specifically in the filiform papillae of the dorsal surface of the tongue. Additionally, none of the tongue cancer tissue samples were K36-positive. Immunostaining also revealed that K36 was expressed in nail beds, Hassal's corpuscles in the thymus and the hair cortex. However, K36 was not expressed in the squamous epithelia of the skin, cervix and oesophagus, and the squamous cells of cervical carcinomas, basal cell carcinoma or melanoma. The present data indicated that K36 may be inactivated in tumours of the tongue. However, whether this is part of the tumoural process or if it is an effect of the tumour itself remains to be elucidated.

Purpose : We report our study on two patients to highlight the risk of underdosage of the clinical target volume (CTV) due to edema during high-dose-rate interstitial brachytherapy (HDR-ISBT) of mobile tongue cancer. Material and methods : To treat the lateral side of the CTV, flexible applicator tubes were implanted on the mouth floor. Two-dimensional planning was performed using X-ray images for Case 1, and three-dimensional (3D) planning was performed using computed tomography (CT) for Case 2. Prescribed doses for both cases were 54 Gy in nine fractions. Case reports : Case 1 was treated for cancer of the right lateral border of the tongue in 2005. Tongue edema occurred after implantation, and part of the lateral border of the tongue protruded between the applicator tubes. Acute mucosal reaction abated in the protruded area earlier than in the other parts of the CTV. In this case, the tumor recurred in this area 5 months after the treatment. Case 2 was treated for cancer of the left lateral border of the tongue. Because tongue edema occurred in this case also, plastic splints were inserted between the applicator tubes to push the edematous region into the irradiated area. The mucosal surface of the CTV was covered by the 70% isodose, and 100% isodose line for before and after splint insertion. Local control of the tumor was achieved 4 years after treatment. Discussion and conclusions : To ensure sufficient target coverage, 3D image-based planning using CT should be performed, followed by re-planning using repeated CT as needed. Also, the development of devices to prevent protrusion of the edematous tissue outside the target area will help to ensure the full dosing of CTV.

Resume Objectifs de l’etude Les carcinomes epidermoides de la cavite buccale du sujet jeune constituent une entite specifique dont la prise en charge et le pronostic sont discutes. Nous avons effectue une analyse retrospective des dossiers de l’ensemble des patients âges de moins de 40 ans et pris en charge a Gustave-Roussy pour un carcinome epidermoide de la cavite buccale entre 1999 et 2011. Methodes Les caracteristiques des patients, des tumeurs, du traitement, et le devenir ont ete enregistres. Une analyse de survie par la methode de Kaplan-Meier a ete realisee, ainsi qu’une analyse unifactorielle et multifactorielle a la recherche de facteurs pronostiques de la survie globale et la survie sans progression. Resultats Soixante-trois patients ont ete identifies. Le suivi median etait de 64 mois. La majorite des tumeurs siegeait au niveau de la langue mobile (n = 54, 86 %). Au total 17 patients sont decedes, dont 15 du cancer traite. Les taux de survie globale et sans progression a 5 ans etaient de 80 % et 69 %. Les taux de survie sans rechute locale, regionale ou metastatique a 5 ans etaient de 80 %, 91 % et 89 %. En analyse multifactorielle, seule l’absence de chirurgie initiale etait pronostique pour la survie globale (hazard ratio [HR] : 13,5 [2,0 ; 90,5], p = 0,007), tandis que la consommation d’alcool (HR : 0,38 [0,15 ; 0,9], p = 0,03) et l’absence de chirurgie (HR : 9,8 [1,9 ; 50,9], p = 0,006) etaient associees a une diminution de la probabilite de survie sans progression. Un âge plus jeune (moins de 30 ans) n’etait pas associe ni a la survie globale ni a celle sans progression. Conclusion Les taux de survie et de controle tumoral sont relativement eleves chez les sujets jeunes atteints de carcinome epidermoide de la cavite buccale traites dans un centre tertiaire. L’identification pretherapeutique des sujets a risque de recidive est actuellement difficile. La balance entre risque de rechute et toxicite des traitements justifie la realisation d’etudes supplementaires, sur le plan clinique et pour le developpement de biomarqueurs pronostiques.

Various morphological measures demonstrate convergent evolution in ruminants with their natural diet, in particular with respect to the browser/grazer dichotomy. Here, we report quantitative macroanatomical measures of the tongue (length and width of specific parts) of 65 ruminant species and relate them to either body mass (BM) or total tongue length, and to the percentage of grass in the natural diet (%grass). Models without and with accounting for the phylogenetic structures of the dataset were used, and models were ranked using Akaike's Information Criterion. Scaling relationships followed geometric principles, that is, length measures scaled with BM to the power of 0.33. Models that used tongue length rather than BM as a body size proxy were consistently ranked better, indicating that using size proxies that are less susceptible to a wider variety of factors (such as BM that fluctuates with body condition) should be attempted whenever possible. The proportion of the freely mobile tongue tip of the total tongue (and hence also the corpus length) was negatively correlated to %grass, in accordance with concepts that the feeding mechanism of browsers requires more mobile tongues. It should be noted that some nonbrowsers, such as cattle, use a peculiar mechanism for grazing that also requires long, mobile tongues, but they appear to be exceptions. A larger corpus width with increasing %grass corresponds to differences in snout shape with broader snouts in grazers. The Torus linguae is longer with increasing %grass, a finding that still warrants functional interpretation. This study shows that tongue measures covary with diet in ruminants. In contrast, the shape of the tongue (straight or "hourglass-shaped" as measured by the ratio of the widest and smallest corpus width) is unrelated to diet and is influenced strongly by phylogeny.

Background: Tongue squamous cell carcinoma (TSCC) is increasing in incidence, especially among young patients and preferably females. Infection with human papilloma virus (HPV) has been suggested as a cause of SCC in the head and neck, and the proportion of oropharyngeal cancers caused by HPV has steadily increased. Methods: Samples from 109 patients with primary TSCC were analysed for the presence of HPV16 by in situ hybridisation and for expression of its surrogate marker p16 and the HPV receptor syndecan-1 by immunhistochemistry. Results: No evidence of HPV16 DNA was observed in the tumours, although one-third showed p16 staining. There was no difference in the expression of the primary HPV receptor, syndecan-1, between TSCC and a group of tonsil SCC. Conclusion: Whereas p16 is expressed in some TSCCs, HPV16 is undetectable, therefore, p16 cannot be used as a surrogate marker for high-risk HPV-infection in this tumour. Despite presence of the HPV-receptor syndecan-1 in TSCC, HPV prefers the tonsillar environment. Lack of p16 associates with worse prognosis primarily in patients aged ⩽40 years with tongue SCC. The improved prognosis seen in p16-positive TSCC can be due to induction of a senescent phenotype or an inherent radiosensitivity due to the ability of p16 to inhibit homologous recombination repair.

Shadows and chromatic aberration problems are existed in the mobile tongue images, which result in tongue images obtained from the mobile devices cannot be directly used for auxiliary diagnosis. To better acquire the color features of the tongue images, we analyze the HIT tongue database and our mobile tongue dataset. Comparing to the HIT tongue database, we found insufficient exposure might be the root cause of above problems in the mobile tongue dataset. Therefore, we propose a two-stage color correction algorithm to effectively solve two problems. To remove the shadows in the tongue images, Frankle-McCann retinex algorithm is implemented. Then, to restore the whole color distribution of the tongue images as real world, the gray world algorithm is utilized to fine-tune the color values of the tongue images. Qualitative and quantitative analysis show that the proposed algorithm can achieve good objective and real visual results.

Purpose: To compare the outcome of our facility with another about the shortened schedule (60 Gy in 10 fractions to 54 Gy in 9 fractions) of high-dose-rate interstitial brachytherapy (HDR ISBT) for mobile tongue cancer. Material and methods: Eighteen patients were treated with HDR ISBT as a monotherapy in dose reduction schedule with some unique technique to determine the border of tumor accuracy (lugol’s staining and metal marker), and to minimize adverse effect (lead-lined silicon block) at our facility. Results: The 2-year local and regional control rates and cause-specific survival rate were 82%, 80%, and 83% and moderate to severe late complications occurred in five patients (28%), which were almost the same treatment results achieved by another facility. Conclusions: We recommend 54 Gy in 9 fractions over 7 days as a feasible treatment to reduce patient discomfort in mobile tongue cancer patients. J Contemp Brachytherapy 2014; 6, 1: 10–14 DOI: 10.5114/jcb.2014.40726

Rationale:Adenoid cystic carcinoma (ACC) is an infrequent malignant neoplasm of the salivary glands. The clinical and pathological characteristics include slow growth, perineural invasion, and local recurrence. ACC of the mobile tongue is rarely reported in the literature.Patient concerns:We

The presence of a palatal dentition is generally considered to be the primitive condition in amniotes, with each major lineage showing a tendency toward reduction. This study highlights the variation in palatal tooth arrangements and reveals clear trends within the evolutionary history of tetrapods. Major changes occurred in the transition between early tetrapods and amphibians on the one hand, and stem amniotes on the other. These changes reflect the function of the palatal dentition, which can play an important role in holding and manipulating food during feeding. Differences in the arrangement of palatal teeth, and in their pattern of loss, likely reflect differences in feeding strategy but also changes in the arrangement of cranial soft tissues, as the palatal dentition works best with a well-developed mobile tongue. It is difficult to explain the loss of palatal teeth in terms of any single factor, but palatal tooth patterns have the potential to provide new information on diet and feeding strategy in extinct taxa.

INTRODUCTION The facial artery musculomucosal (FAMM) flap was first described in 1992 by Pribaz et al. This flap allows reconstruction of smallto medium-size oral cavity, oropharynx, and intranasal defects. Lateral and anterior floor-of-mouth (FOM) defects have been successfully reconstructed with the FAMM flap, maintaining the tongue mobility and ensuring adequate elocution and the oral phase of deglutition. The FAMM flap can also be used for reconstructions of other subsites of the oral cavity as well as the lip and vermillion reconstruction. However, a second-stage procedure is often needed to reduce the bulky mucosal paddle at the base of the flap, to increase the depth of the vestibule and to allow greater mobility of the mobile tongue. A second-stage procedure is required in approximately one third of the patients. We present herein a modification of the surgical approach of the FAMM flap to allow a one-stage procedure and the surgical outcomes in three cases.

Theocharis S, Klijanienko J, Giaginis C, Rodriguez J, Jouffroy T, Girod A, Point D, Tsourouflis G & Sastre-Garau X (2011) Histopathology59, 514–525 Metallothionein expression in mobile tongue squamous cell carcinoma: associations with clinicopathological parameters and patient survival Aims: Metallothionein (MT) has been implicated in several aspects of cancer pathobiology, such as differentiation, proliferation, apoptosis and invasion. The aim of the present study was to evaluate the clinical significance of MT expression in mobile tongue squamous cell carcinoma (SCC). Methods and results: MT protein expression was assessed immunohistochemically on 49 mobile tongue SCC specimens, and was analysed in relation to clinicopathological characteristics, and overall and disease-free patient survival. All of the examined mobile tongue SCC cases showed MT positivity in tumour cells; however, neither MT overexpression nor staining intensity was significantly associated with clinicopathological parameters. MT cellular distribution was significantly associated with histopathological grade of differentiation and depth of invasion (P = 0.0188 and P = 0.0484, respectively). MT staining intensity was identified as a significant predictor of overall patient survival at both univariate (P = 0.0377) and multivariate (P = 0.0472) levels. Twenty-seven (55.10%) of the examined SCC cases showed MT positivity in squamous tongue epithelium adjacent to the tumour, the MT positivity being correlated with depth of invasion (P = 0.0281), vascular invasion (P = 0.0194), and the existence of lymph node metastases (P = 0.0194). Conclusions: MT may be implicated in the development and progression of mobile tongue SCC and could be considered as a useful clinical marker for patient management and prognosis.

Impactions of the orofacial region are rare but impactions of the mobile tongue are unique. Hence, very limited literature is available. Foreign bodies embedded in the maxillofacial region frequently result from trauma and dental treatment. This is a compilation of cases of tongue impaction, tooth in maxillary sinus and watch battery impacted in tooth. A brief insight into the incidence of orofacial impactions, radiographic investigations and management is also provided.

1994～2005年にイリジウムヘアピンを用いた低線量率組織内照射を行った早期舌癌152例のうち，2004年以降に治療した20例に対して刺入操作中に超音波検査を行うことによって腫瘍に対する線源位置の改善を図った。この超音波検査が治療成績に与えた影響を検討した。局所再発は2003年以前では全例中17例（13%）に生じていたが，2004年以降では1例（5%）へと減少した。特にT2症例では14例の全例が制御された。放射線潰瘍は2003年以前では64例（57%）に生じていたが，2004年以降では9例（47%）に減少した。放射線潰瘍は1例を除き全例で保存的療法により6ヶ月未満で消退した。刺入操作中に超音波検査により線源位置を確認することによって腫瘍に対して確実に線量を投与できたことが局所制御の向上に寄与したものと思われた。

Adenoid cystic carcinoma (ACC) is an infrequent malignant neoplasm of the salivary glands. We present a case of a 70-year-old male patient with a swelling over the dorsal and ventral surface of anterior two third of the tongue which was causing him difficulty in mastication since 10 months. Ultrasound and magnetic resonance imaging were done following which the surgical excision of the lesion was performed and histopathological diagnosis of ACC was achieved. It was rare to find ACC in such an old man with such a large lesion presenting so late in the rare site of the mobile tongue. ACC is a slowly growing, highly invasive cancer with a high recurrence rate and chances of metastases, so surgery is the choice of treatment with mandatory long-term follow-up.

Objectives To analyze the treatment results and late complications of high-dose-rate (HDR) interstitial brachytherapy (ISBT) for early (T1N0, T2N0) mobile tongue cancer using the microSelectron-HDR.

Purpose : To evaluate the treatment results of low-dose-rate (LDR) and high-dose-rate (HDR) interstitial brachytherapy (ISBT) for T3 mobile tongue cancer. Material and methods : Between 1974 and 1992, 61 patients with T3 mobile tongue cancer were treated with LDR ISBT using 192 Ir hairpins with or without single pins. In addition, between 1991 and 1999, 14 patients were treated with HDR ISBT. For nine patients treated with ISBT alone, the total dose was 59–94 Gy (median 72 Gy) within one week in LDR ISBT and 60 Gy/10 fractions/5 days in HDR ISBT. For 66 patients treated with a combination therapy of external beam radiotherapy (EBRT) and ISBT, the total dose was 12.5–60 Gy (median 30 Gy) of EBRT and 50–112 Gy (median 68 Gy) within 1 week in LDR ISBT or 32–60 Gy (median 48 Gy)/8–10 fractions/5–7 days in HDR ISBT. Results : The 2- and 3-year local control rates of all patients were both 68%. The 2- and 3-year local control rates of patients treated with LDR ISBT were both 67%, and those with HDR ISBT were both 71%. The local control rate of patients treated with HDR ISBT was similar to those with LDR ISBT. Conclusions : ISBT for T3 mobile tongue cancer is effective and acceptable. The treatment result of HDR ISBT is almost similar to that of LDR ISBT for T3 mobile tongue cancer.

Objectives To analyse the treatment results of high dose rate (HDR) interstitial brachytherapy (ISBT) for early (T1N0, T2N0) mobile tongue cancer using microSelectron-HDR.

Objectives: The assessment of the expression patterns of cytokeratin polypeptides (Cks) and vimentin in normal epithelium of the mobile tongue and floor of the mouth, squamous cell carcinomas and their lymph node metastases. Material and Methods: Chain-specific monoclonal antibodies to various Cks and vimentin were used, employing the immunoperoxidase technique. Results and Conclusions: Profound changes in the expression of pre-existing Cks and de novo expression of simple epithelium-related Cks and of vimentin occurred upon malignant transformation and tumor progression. Changes were mainly related to the degree of cellular differentiation, tumor cell morphology and tumor growth pattern. Low-grade tumors showed a pronounced decrease of the stratification Cks 4 and 13, and an increase of Cks 14, 16, and 17. With increasing tumor grade, expression of Cks 16 and 17 decreased. De novo expression of Cks 8 and 18 and of vimentin was most marked in high-grade tumors, in tumors with a basaloid phenotype and in tumors growing in small infiltrating tumor fields; it was proposed to be associated with poor prognosis.

Foreign bodies embedded in a mobile tongue as an enlarged tongue mass are rarely presented to either a laryngologist or a dentist, because such bodies are commonly lodged superficially and are easily removed by the patients themselves or removed by a laryngologist by means of indirect laryngoscope or endoscope. We have described a 63-year-old female with an 8-month history of an enlarged mass in the anterior right tongue. Physical examination demonstrated a mass located in the anterior right tongue without clear margin, with superficially intact mucosa and normal colour. A benign tongue neoplasm was first considered. However, a fish bone totally embedded in the mobile tongue with granuloma formation was encountered during the incisional biopsy operation. Complete removal of the foreign body with granuloma was achieved under general anaesthesia. There was no neuromuscular or neurosensory dysfunction of the tongue in the follow-up period of 2 years. Although an embedded foreign body in the mobile tongue is a rare condition, it should be considered in the work-up of a patient with an enlarged tongue mass, with or without a history of swallowing a foreign body.

Cranio-dental characteristics are quantified between micro- and megachiropteran nectarivores and compared with microchiropteran animalivores, frugivores, and megachiropteran frugivores. Microchiropteran nectarivores share many characteristics with megachiropteran nectarivores and frugivores, but differ in having a long, narrow head. Megachiropterans have wide zygomata, which would allow for more jaw musculature. Diminutive cheekteeth are characteristic of nectarivory in both suborders, but both have relatively large canines. Teeth in nectarivores can occupy as little as a tenth of the palatal area compared to nearly two-thirds in microchiropteran animalivores. The proportion that the dilambdodont stylar shelf occupies of molars in microchiropteran nectarivores can be as much as that in microchiropteran animalivores (insectivorous and carnivorous bats) or as little as that in microchiropteran frugivores but not as extreme as either. In addition to dimunitive teeth, nectarivores have fused mandibles and upper canines that are worn from contact with the lower canines (thegosis). These characteristics may be necessary for the lower jaw to support an elongated, mobile tongue. While microchiropteran nectarivory, frugivory, and carnivory probably evolved independently from an insectivorous microchiropteran ancestor, megachiropteran nectarivory probably evolved from megachiropteran frugivory or the reverse.

PURPOSE:To point out the advantages and drawbacks of high-dose rate brachytherapy in the treatment of mobile tongue cancer and indicate the clinical importance of modular lead-lined spacers when applying this technique to patients. METHODS:First, all basic steps to construct the modular spacer are shown. Second, we simulate and evaluate the dose rate reduction for a wide range of spacer configurations. RESULTS:With increasing distance to the source absorbed doses dropped considerably. Significantly more shielding was obtained when lead was added to the spacer and this effect was most pronounced on shorter (i.e. more clinically relevant) distances to the source. CONCLUSIONS:The modular spacer represents an important addition to the planning and treatment stages of mobile tongue cancer using HDR-ISBT.

Objective: Various lymphoscintigraphic imaging protocols exist for sentinel node (SN) identification in early-stage oral cancer. This study aimed to evaluate the clinical value of performing additional late lymphoscintigraphic imaging. Methods: We retrospectively analysed early (directly following injection of 99mTc-Nanocoll) and late (2-4 h after injection) imaging results of 60 early-stage (T1-T2, cN0) oral cancer patients scheduled for SN procedure. Lymphoscintigraphic results of late imaging were categorized into: (a) no visualization of additional hotspots considered to be SNs; (b) additional hotspots visualized that are considered to be SNs and (c) hotspots visualized only during late imaging. Histopathological results of the harvested SNs were related to the corresponding hotspot. Results: In all patients (n=60) lymphoscintigraphy was able to visualize a hotspot that was identified as an SN. In 51/60 (85%) patients, early imaging was able to visualize at least one hotspot, whereas in 9/60 (15%) patients, mostly with oral cavity tumours other than mobile tongue and floor-of-mouth tumours, only late imaging was able to visualize hotspots. In 14/51 (27%) patients, late imaging resulted in additionally visualized hotspots marked as SNs, resulting in a more extensive surgical procedure. These additionally removed SNs appeared to be of no clinical relevance, as all SNs identified during early imaging correctly predicted whether the neck was positive or negative for cancer.Conclusion: Results of this study indicate that additional late lymphoscintigraphic imaging should be performed only in selected cases.