Tumours of the oral cavity

Oral tumours are a common malignancy, with smoking and alcohol the principal aetiological factors. Squamous cell carcinoma is the commonest pathology, most frequently affecting the anterior tongue and floor of the mouth. Surgery is the mainstay of T1/T2 tumour management, and tracheostomy may be required. Sentinel node biopsy is an effective staging procedure; however, there is a high rate of occult nodal metastasis which may warrant elective supraomohyoid neck dissection. Macroscopic nodal disease requires modified radical neck dissection, preferably with adjuvant chemoradiotherapy. For unresectable tumours, radical external beam radiotherapy with cisplatin should be given. Reconstruction of soft tissue involves a range of skin grafts and local, regional, and free flaps, while bony reconstruction includes obturators and non-vascularized and vascularized bone grafts. Postoperative rehabilitation aims to restore speech, mastication, swallow, and dentition. Three-year survival is greater than 90% for stage I/II disease, with excellent functional outcomes.

Precise Intraoperative Lymph Node Identification by Isosulfan Blue of Occult Neck Lymph Node Metastases for Decision to Convert from Supraomohyoid Neck Dissection to Comprehensive Neck Dissection in Early-Stage Oral Cancer

Objective: To study the sensitivity and specificity of peritumoral isosulfan blue dye injection for localization of suspected metastatic lymph nodes. Materials and methods: The study included all patients diagnosed with early-stage oral cancer between January 2018 and March 2020. After elevation of the skin flap, the primary site was injected peritumorally with isosulfan blue 0.3-0.5 cc at 1 cm intervals and massaged. The time at which any draining nodes turned blue was recorded and the node was then excised for frozen section. After which supraomohyoid neck dissection was performed. The frozen sections were stained with H&E and analyzed for presence of metastases. Negative sections were further analyzed using immunohistochemistry stains. Sensitivity, specificity and time of identification suspected metastatic lymph node were analyzed . Results: Nineteen patients with early-stage oral cancer were included. The majority (78.4%) presented with tongue lesions. The mean injection amount administered was 3.62±0.83 cc, and the number of injections around the tumor were 10.26±2.31. Mean duration from time of injection to the identification of a blue node was 19.26±15.99 min. Nodes at Level I of the neck were the most common identified as blue nodes (57.8%). Statistical analysis comparing pathological findings with blue node identification revealed this technique has a sensitivity of 71.4% with specificity of 91.7% and an overall accuracy of 84.2% in identify metastasis lymph node. Conclusion: Isosulfan blue injection of primary oral tumors demonstrated a high level of efficiency in identifying metastatic lesions in draining lymph nodes. This technique may be helpful in deciding intraoperatively whether to convert from supraomohyoid neck dissection to comprehensive neck dissection .

A Clinical Comparison of the Efficacy of Level I-III Versus Level I-IV Neck Dissection in N0 Early Stage Tongue Squamous Cell Carcinoma

In this study, we compared regional recurrence in patients who had a dissection of levels I-III or levels I-IV. Patients with tongue SCC who were node-negative both clinically and radiologically, and underwent elective supraomohyoid neck dissection (SOHND) or extended supraomohyoid neck dissection (ESOHND) between March 2012, and March 2015 were retrospectively reviewed. The two therapeutic groups were analyzed for the incidence of tumor recurrence and survival. The two groups had statistically similar demographic qualities. Surgery duration and complications were the same in both groups. Complications mainly included internal jugular vein and thoracic duct injury. Tumour size was 46.2% T1, 40.4 % T2, and 13.3% Tx, being statistically similar in both groups. Tumour size had no meaningful correlation with the occurrence of occult neck metastasis in both groups. Local recurrence was more in ESOHND patients, but regional recurrence was similar in both groups. The survival rate was alike in both groups. No significant differences in tumor recurrence and mortality rate were found between patients treated with SOHND versus ESOHND. Thus, SOHND could be considered as a sufficient treatment for early-stage tongue SCC.

Bilateral Karapandzic flap: a work horse for carcinoma of lower lip

<p class="abstract">The lips are major aesthetic components of the face, which are also necessary for facial expression, speech, and eating. In oncological resections, the main goal in lip reconstruction is achieving oral competence than speech and facial expressions. Malignant lesions involving lip warrant a wide excision to ensure a disease-free margin, which usually results in large defects. Defects up to 1/3rd of lips are closed primarily. Defects measuring 1/3rd to 2/3rd of the lower lip may be closed with Karapandzic, Abbe or Estlander flaps. A 45-year-old male presented with an exophytic lesion in the lower lip involving the facial skin with bilateral level 1b cervical lymphadenopathy. Contrast-enhanced computed tomography scan showed heterogeneous irregular lesion over the lower lip with bilateral enlarged necrotic level 1b cervical lymphadenopathy. Biopsy from the lesion was suggestive of moderately differentiated squamous cell carcinoma. Wide local excision with left modified radical neck dissection and right supraomohyoid neck dissection was done. The central lower lip defect was reconstructed with bilateral Karapandzic flap. The postoperative period was uneventful, although the patient had microstomia. The patient was advised adjuvant radiotherapy based on histopathology and was in regular follow up.</p>

Adenoid Cystic Carcinoma With Sialolithiasis of the Left Submandibular Gland: A Case Report and Literature Review

Adenoid cystic carcinoma is one of the most common salivary gland malignancies with poor long-term prognosis, but the coexistence of sialoliths is extraordinarily rare. In this article, we report a case of 30-year-old woman with a history of submandibular area swelling with intermittent pain increasing during mealtimes that had led her attending physician to diagnose a sialolith in the left submandibular gland on a radiograph 10 years before. However, the surgical specimen proved to be an adenoid cystic carcinoma accompanied with a sialolith. Histopathologically, the submandibular gland was displaced with a fibrous granulation tissue containing a small cribriform carcinoma invading the extracapsular region of the gland. We performed fluorescence in situ hybridization examination with an MYB-NFIB fusion probe of the lesion, with positive results. The patient underwent a supraomohyoid neck dissection as additional procedure because of the possibility of the extracapsular cancer nest remaining around the submandibular gland, but she remains well and disease free 11 years after the first operation.