Tongue Morphology in Horned Lizards (Phrynosomatidae: Phrynosoma) and its Relationship to Specialized Feeding and Diet

In lizards, the tongue is joined to the mandible by the median genioglossus medialis muscle and the larger, paired genioglossus lateralis muscles. These muscles run through a frenulum and along the sides of the tongue, forming its walls. In horned lizards, however, the genioglossus lateralis muscles fail to join the tongue for most of its length, forming separate ridges evident in the floor of the mouth lateral to the body of the tongue. This unique tongue morphology co-occurs with horned lizards’ ability to consume large numbers of potentially lethal harvester ants, a diet enabled by a feeding mechanism in which ants are rapidly immobilized with strings of mucus before immediate swallowing. Circumstantial evidence implicates the unusual morphology of the genioglossus lateralis muscles in the mucus-binding system.

Uremic Stomatitis: A Case Report

Uremic stomatitis is a rarely reported oral mucosal disorder associated with renal disorder. It is mostly seen in cases of end stage renal disease or undiagnosed or untreated chronic renal failure. Its frequency has diminished due to the advent of renal dialysis. Clinically uremic stomatitis is characterised by the presence of painful plaques and crusts that are usually distributed on the buccal and labial mucosa, dorsal or ventral surface of the tongue, gingiva and the floor of the mouth. Ultimate treatment consists of improvement of blood urea concentration and underlying renal failure is supported by enhancement of oral hygiene with antiseptic mouthwashes and antimicrobial/ antifungal agents, if necessary. Here we report a case of a 50 year old Male patient who reported to the department with the complaint of inability to open mouth due to ulcers present intra-orally, who was a kidney patient undergoing dialysis, who was then treated with topical steroid and antifungal medications with follow up made once in a week.

Histiocytoid Giant Cellulitis-Like Sweet Syndrome At The Site of Sternal Aspiration: A Case Report

Background: Sweet syndrome with both histiocytoid pathology and giant cellulitis-like lesion feature is extremely rare and has only been reported once. Our case is different from the previous report because the cutaneous lesion was caused by local invasive irritation, which made it much more difficult to distinguish from cellulitis.Case presentation: A 52-year-old male was diagnosed with myelodysplastic syndrome with multilineage dysplasia (MDS-MLD) associated with myelofibrosis (MDS-F) as well as angioneurotic edema of the tongue and floor of the mouth. Seven days after sternal aspiration, a cellulitis-like lesion was formed at the puncture site. Since he had neutropenia, history of glucocorticoid use and didn't keep the site dry and clean after aspiration, cellulitis was diagnosed, followed by broad-spectrum antibiotics and debridement. However, the lesion continued to expand, associated with blisters formation, accompanied by chills and fever. Blood cultures and blister smears didn't detect any pathogens. Biopsy of the lesion was performed and histiocytoid Sweet syndrome was diagnosed. He received prednisone treatment, and the fever relieved within 24 hours and the cutaneous lesion resolved within one week. He has had no recurrence during two-month follow-up.Conclusions: This case can provide help for timely diagnosis and treatment and a reference for further summarizing the characteristics of this rare variant.

Comparison of Different Staging Systems Applied to a Cohort of Patients With Oral Tongue and Floor of the Mouth Cancer

Purpose: The present work compares the effects produced by the application of the 7th edition of the tumor node metastasis (TNM) staging system (TNM7), 8th Edition (TNM8) with its two subsequent revisions, and pN-N+ classification on a cohort of patients with oral tongue and floor of the mouth cancer.Methods: A monocentric cohort of 148 patients was retrospectively analyzed. Patients were staged according to the TNM7, TNM8 and revisions, and pN-N+ classification. Stage migration was assessed and overall survival (OS) analyzed with the Kaplan–Meier method. The pT, pN, and stage stratification was evaluated with univariate and multivariate Cox regression and comparing adjacent categories with the log-rank method.Results: pT3-T4a categories showed significant differences in comparison to pT1-T2 for each staging metric employed in both uni- and multivariate analysis. When comparing adjacent pT categories, OS was significantly different only between pT2 and pT3 categories of the TNM8. Disproportionate patient distribution among pN categories was observed in the TNM8, and stratification was scarce. Conversely, in the pN-N+ classification the difference between pN2 and pN3a categories was significant. Only stage IVa reached statistical significance in TNM7, whereas stage III and above were significant in TNM8 and revisions in both uni- and multivariate analysis. However, no significant difference was noted comparing adjacent stages.Conclusion: The TNM8 pT classification differentiated low- from high-risk diseases. Nonetheless, it failed to separate pT1 from pT2 and pT3 from pT4a categories. Conversely, although TNM8 nodal staging was inaccurate, the number of metastatic lymph nodes was more valuable.

A new method for temporary partial osteoplastic resection of the mandible for the removal of tongue cancer

Wide access to the oral cavity is necessary for surgeons, mainly for the surgical treatment of tongue cancer with localization of the neoplasm in the posterior parts of the latter, especially when the cancer transitions to the mucous membrane of the floor of the mouth or to the arcus palato-glossus.

A Case of Ectopic Odontogenic Ghost Cell Tumor: Histogenetic Features of a New Entity

Background: Odontogenic tumors arising from extra-alveolar sites are extremerly rare. Dentinogenic ghost cell tumor (DGCT) is an uncommon odontogenic neoplasm characterized by CTNNB1 mutation, ghost cell appearance, and dentinoid-like calcification. We present a case of an ectopic DGCT arising from a calcifying odontogenic cyst in the floor of the mouth. Case presentation: A 72-year-old man presented with a painless sublingual swelling. Imaging revealed a multi-lobulated, solid-cyst mass on the floor of the mouth. Cytology showed folded epithelial clusters composed of basaloid cells, keratinized material, and dentinoid matrix. Histology also revealed a multi-cystic, cribriform to solid nest. Immunohistochemically, CK19, CK5/6, bcl-2, and p63 were diffuse positive. CTNTTB1 mutation was detected, leading to the final diagnosis of an ectopic DGCT. There was no recurrence during a 6-month follow-up. Conclusion: This is the first report to comprehensively describe the clinicopathological features of an ectopic DGCT of odontogenic origin, developing similarly to that of a true odontogenic DGCT. Accurate diagnosis of this rare entity is necessary to avoid overtreatment.

Functional Outcomes with Facial Artery Musculo-Mucosal (FAMM) Flap and Dental Implants for Reconstruction of Floor of the Mouth and Tongue Defects in Oncologic Patients

Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who had been diagnosed with intraoral SCCA affecting the tongue and the floor of the mouth and who had undergone wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap and immediate osseointegrated implants were assessed. Lingual mobility, speech articulation, deglutition, implant success rate, mouth opening, and aesthetic results were evaluated. All patients were staged as T2 and the defect size ranged from 3.7 × 2.1 cm to 6.3 × 4.2 cm. A selective neck dissection was performed in all patients as part of their oncologic treatment, either electively or for node positive disease. Thirteen patients (59%) were diagnosed with node positive disease and underwent adjuvant radiotherapy. A total of 101 osseointegrated implants were placed for prosthetic rehabilitation and 8 implants were lost (7.9%), of which 7 received radiotherapy (87.5%). The implant success rate was 92.1%. Mouth opening was reported as normal in 19 patients (86.3%). Tongue tip elevation was reported as excellent in 19 patients (86.3%) and good in 3 patients (13.6%). Lingual protrusion was referred to as excellent in 15 patients (68.2%) and good in 6 patients (27.2%). Lateral excursion was reported as excellent in 14 patients (63.6%) and good in 7 patients (31.8%). In terms of speech articulation, 20 patients reported normal speech (90.9%). Regarding deglutition, 19 patients (86.3%) reported a regular diet while a soft diet was reported by 3 patients (13.7%). Aesthetic results were referred to as excellent in 17 patients (77.3%). FAMM flaps, immediate implants and fixed prostheses enable the functional rehabilitation of oncologic patients, optimizing aesthetics and functional outcomes even in patients undergoing irradiation, thus returning oncologic patients to an excellent quality of life.