Quality of life after mandibulectomy: the impact of the resected subsite

The purpose of this study was to identify the factors that impact the quality of life (QOL) scores of patients undergoing mandibulectomy.All patients with a diagnosis of an oral cavity neoplasm involving the mandible who underwent a mandibulectomy between January 1, 2000 and December 31, 2015 and completed a University of Washington QOL questionnaire (UW-QOL) were included in the study.Fifty-eight patients fulfilled all inclusion criteria and completed the UW-QOL questionnaire. Forty patients (69%) underwent a segmental mandibulectomy and 18 patients underwent a marginal mandibulectomy. Forty-eight patients (82.7%) had a free flap reconstruction. There was no significant difference in the QOL scores between patients who underwent a marginal or a segmental mandibulectomy. In contrast, patients who underwent symphysial resection reported significantly worse scores in various domains compared to patients with body or ramus segmental mandibulectomy.Patients who underwent a segmental mandibulectomy that included the symphysis had worse outcomes in chewing, recreation, health-related and social QOL domains compared to those whose mandibulectomy did not include the symphysis.     

腹壁下动脉穿支皮瓣在全舌癌缺损修复中的应用效果评价

目的: 评价游离腹壁下动脉穿支皮瓣（deep inferior epigastric perforator,DIEP）用于舌癌术后全舌缺损修复的效果。方法: 2018年1月—2018年7月应用游离DIEP修复13例舌癌患者,手术缺损部位均为全舌或近全舌缺损。术中将腹壁下动脉与甲状腺上动脉或面动脉吻合,伴行静脉与颈外静脉或颈内静脉属支吻合。结果: l3例DIEP皮瓣均修复成功,皮瓣外观满意。术后随访舌形态良好,功能满意。供区直接闭合,其中1例患者皮瓣供区出现感染,经换药后愈合。所有腹部伤口均为线性瘢痕,腹直肌功能未受明显影响,未发现腹壁疝和腹壁隆起等手术并发症。结论: 腹壁下动脉穿支皮瓣组织量丰富、血供可靠、质地柔软,再造舌外形及功能良好,且供区保留了腹直肌和前鞘,损伤小,将供区并发症降到最低限度,是舌癌术后全舌缺损修复新的可靠技术。     

A preliminary and clinical study of radiation therapy for tongue carcinoma

Four hundred and seventy-four patients with squamous cell carcinomas of the tongue were treated with radiation therapy at the Department of Radiology, Osaka University Hospital between 1978 and 1987. Brachytherapy was mainly employed for the majority of the patients with T1 and T2 lesions, whereas the combination of external irradiation and brachytherapy was the treatment of choice for the patients with infiltrative T2 and more advanced lesions. Patients treated with brachytherapy alone were given an estimated tumor dose of about 70Gy within a week. Patients treated with the combined therapy received an estimated tumor dose of about 30Gy to 50Gy within 3 to 5 weeks from external irradiation, followed by 50Gy to 60Gy within a week from brachytherapy. The treatments used in this study improved the survival. The 2-year local control rates were 85% in T1, 77% in T2, 60% in T3 and 33% in T4 lesions. The 5-year actuarial survival rates according to the T stage were 78% in T1, 64% in T2, 50% in T3 and 40% in T4 lesions. One hundred and four patients(28%) of three hundred and sixty nine patients who had negative lymph nodes clinically had cervical lymph node metastases subsequently. Whereas twenty six patients(25%) of one hundred and five patients who had positive lymph nodes clinically proved to be false positive. The incidence of osteoradionecrosis was 6.0% in patients treated with the combination of external irradiation(30Gy) and brachytherapy(60Gy), while it was 1.7% in patients treated with brachtherapy alone(70Gy). Brachytherapy is a fairly good therapeutic technique for the majority of the patients with tongue cancers. The multicombined treatment modality could provide the chance for cure of advanced lesions.     

Granular cell tumour of tongue: A case report

Granular cell tumour, also known as Abrikossoff tumour, is a relatively uncommon benign neoplasm, which is more commonly found in females in the 4th to 6th decades of life even though it can occur in all ages.It occurs in all areas of the body but about 45–65% of all lesions are reported in the head and neck region. Intraoral lesions represent about 70% of the granular cell tumours of the head and neck, and account for 1/3 of all cases affecting the whole body.Most of the intraoral lesions occur on the tongue, usually on the lateral aspect, followed by the buccal mucosa and hard palate. Although majority of granular cell tumours are benign, some are clinically aggressive and a few frankly malignant forms have been reported. Some benign lesions exhibit surface ulcerations and this clinical appearance, combined with the overlying pseudoepitheliomatous hyperplasia, seen histologically, may lead to misdiagnosis of malignancy if adequate biopsy material was not taken.A case of granular cell tumour which occurred on the midline area of the dorsum of the posterior 1/3 of the tongue is reported in a 20-year-old female patient. It is interesting because the patient was younger than the average age of occurrence and the tumour occurred in a similar site to that of a lingual thyroid.     

Interstitial brachytherapy for carcinoma of the tongue using microSelectron-HDR

Objectives To analyse the treatment results of high dose rate (HDR) interstitial brachytherapy (ISBT) for early (T1N0, T2N0) mobile tongue cancer using microSelectron-HDR. Methods From January 1993 through January 1999, a total of 63 patients with squamous cell carcinomas of the early mobile tongue were treated with microSelectron-HDR (HDR: high dose rate) interstitial brachytherapy at the Department of Radiology, Osaka University Medical School. Tumors were located at the lateral border and ventral surface of the mobile tongue. Nineteen percent of all cases were treated with a combination of prior external radiation and HDR ISBT. Eighty-one percent of all cases were treated with HDR ISBT alone. In the case of HDR ISBT alone, all of which were administered a total dose of 54 Gy/9 fractions/5 days or 60 Gy/10 fractions/8 days. In a combined therapy with an external dose of 30 Gy to 40 Gy, HDR ISBT was given at a total dose of 42–48 Gy. Results The local control rate was 84% for HDR IsBT alone and 75% for combined therapy. The difference in the results of HDR ISBT alone and combined therapy was not significant. Nodal metastasis of patients with T1 was 29% (5/17), and that of T2 was 47% (16/34) in the HDR ISBT-alone group and 25% (3/12) in the combined therapy group. Conclusions HDR ISBT is useful and easily applied under local anesthesia to early or superficial lesions of the mobile tongue. In addition, this method can eliminate radiation exposure to the medical staff.     

Human papillomavirus in carcinomas of the tongue: clinical and prognostic implications

It is not clear whether the presence of human papillomavirus (HPV) in squamous cell carcinomas of the tongue (SCCT) is of etiopathogenic and clinical significance. This study was designed to establish the incidence of HPV in SCCT and to determine the influence of HPV detection on clinical parameters and the prognosis. Clinical and histopathological data of 64 patients with SCCT were collected. Thirty benign lesions of the tongue were analyzed in parallel, in order to compare the HPV incidence and genotypes in these lesions with those of SCCT. Paraffin blocks of all cases were collected and PCR was carried out using SPF10 primers and the INNO-LiPA genotyping methodology. HPV was detected in 26.2% of the patients. Hybridization results showed that all patients except one had high-risk (HR)-HPV. HPV56 was the most common (42.1%), followed by HPV18 (26.3%), HPV16 (10.5%), HPV66 (10.5%), HPV39 (5.3%), and HPV51 (5.3%). The odds ratio of HR-HPV infection in cases vs. controls was statistically significant (9.45, 95% confidence interval 1.18–75.46). Among the results of the univariate analysis correlating the presence of HR-HPV with different clinical parameters, only mortality showed a statistically significant correlation, being higher in HR-HPV patients (odds ratio 3.97, 95% confidence interval 1.07–14.7).     

HER family receptors expression in squamous cell carcinoma of the tongue: study of the possible prognostic and biological significance

J Oral Pathol Med (2010) 39 : 79–86
Objectives:  The squamous cell carcinoma of the tongue (SCCT) is biologically and epidemiologically distinct from other oral cavity cancers and is associated with lower overall survival rates. The role of HER family members (HER-1, HER-2/ neu , HER-3 and HER-4) in the pathogenesis and progression of head and neck squamous cell carcinomas has been demonstrated but no report have focused on SCCT. This study investigated, the expression of all members of the HER family, in a series of SCCT and studied the possible prognostic value and correlation with various clinico-pathological parameters.
Methods:  HER-1, HER-2/ neu , HER-3 and HER-4 expression was analysed by semi-quantitative immunohistochemical staining on paraffin embedded tissue specimens from 40 patients who underwent surgery for SCCT between 1996 and 2006.
Results:  HER-1 was overexpressed in 26 cases (65%), HER-2/ neu in two (5%), HER-3 in 19 (48%) and HER-4 in three cases (8%). No significant correlation was found between clinicopathological variables and expression of HER-1 and HER-2/ neu . HER-3 overexpression was significantly related to nodal stage, age (≥64 years) and decreased overall survival ( P  ≤ 0.05). HER-4 overexpression was significantly associated with low histological grade including when it was coexpressed with HER-3 but in this case the prognosis was worse ( P  < 0.05).
Conclusions:  These results suggest that HER-1 and HER-2/ neu when determined with stringent criteria are not useful indicators of prognosis in SCCT. Only HER-3 overexpression may help in identifying SCCT with greater malignant potential also when it is coexpressed with HER-4. Instead, as in other malignancies, HER-4 could play a protective role in SCCT.     

Revascularization of the tongue by radial forearm flow-through flap

The concept of a flow-through flap refers to a free flap in which both the proximal and distal ends of the vascular pedicle are anastomosed to provide blood flow to the distal tissues. The purpose of this paper is to highlight the use of this technique, which may be useful in selected cases of head and neck reconstruction. In certain situations, like bilateral resection of the base of the tongue involving both lingual arteries, the application of a flow-through forearm free flap can provide an anatomical and functional restoration of the defect while revascularizing the anterior two-thirds of the tongue. We review this technique, which was used in a case of adenoid cystic carcinoma of the base of the tongue with excellent results.     

Oncological outcomes of total glossectomy procedure for advanced tongue cancer: a single-centre experience

Surgeons treating advanced carcinoma of the tongue with total glossectomy face many conflicts in view of the morbidity and poor functional and survival outcomes following surgery. It is pertinent to study the patients undergoing total tongue compartment resection as a separate cohort to analyse their outcomes. This study investigated the oncological outcomes of 150 patients with advanced tongue squamous cell carcinoma who underwent total glossectomy. The results suggest that compartment resection significantly improved local control, irrespective of margin status. The presence of multiple positive nodes was found to be an independent poor prognostic factor, and adjuvant radiation significantly improved survival. Total glossectomy is feasible and safe in both the primary and salvage setting and should be considered as the surgical option for advanced tongue cancer.     

舌正中岛状瓣修复口底缺损

目的：总结应用舌正中岛状瓣修复口底缺损的经验。方法：5例中小型口底缺损患者采用舌正中岛状瓣修复重建。在舌背正中部位制备舌肌黏膜瓣,通过切开舌尖或舌组织隧道以岛状瓣的方式转移修复口底缺损。结果：5例患者术后舌瓣均成活良好,无舌瓣坏死,1例术后一侧舌尖部分坏死。术后随访3-6个月,患者发音及吞咽功能无明显异常。结论：舌正中岛状瓣是一种修复中小型口底缺损的好方法。     

Delayed hypersensitivity or geographic tongue: A diagnostic dilemma

Delayed hypersensitivity can occur following the use of a wide range of materials used in dentistry. These adverse reactions can be either localized or diffuse, and can mimic oral lesions of other aetiology. Delayed hypersensitivity to dental amalgam commonly presents as lichenoid oral lesions. We report the case of a patient who presented to us with burning and itching sensations on the tongue three days after restoration of his lower permanent molars with silver amalgam. Within a day, the initially well circumscribed lesions of the tongue became diffuse. Atrophy of the lingual papillae gave an appearance of a geographic tongue. Following replacement of the amalgam restoration, symptoms rapidly subsided and there was a significant improvement of the lesion.     

舌根部腺泡状软组织肉瘤1例

腺泡状软组织肉瘤是一种少见的软组织恶性肿瘤,组织来源不明,局部呈侵袭性生长并可发生远处转移。本文报告1例发生于舌根部的腺泡状软组织肉瘤并结合相关文献,就其临床表现、组织病理学特征、诊断及治疗进行讨论。     

Results of interstitial radiation therapy with iridium-192 for patients with carcinoma of the oral tongue

Summary Between 1973 and 1985, 286 patients with squamous cell carcinoma of the oral tongue (T1NO: 72; T2NO: 180; T3NO: 34) were treated with Iridium-192 interstitial irradiation at the Department of Radiology, Osaka University Hospital. Five-year control rates of the primary lesion by Iridium-192 implant alone or in combination with external irradiation was 70% (T1: 77%; T2: 71%; T3: 47%), and ultimate local control rate after salvage surgery only for recurrence was 85% (T1: 93%; T2: 87%; T3: 62%). These results are comparable to those obtained by interstitial therapy with radium needles, with the superior advantage of lower risk to the medical staff.     

Relationship between squamous cell carcinoma of the tongue and the position of dental prosthesis

PURPOSE

Squamous cell carcinoma (SCC) of the tongue has a relatively high incidence of all oral cancers. Some studies have reported a relationship between intraoral dental prosthesis and SCC of the tongue; however, this relationship remains controversial. The purpose of this study was to investigate the relationship between SCC of the tongue and the positional aspects of dental prosthesis using a retrospective analysis.

MATERIALS AND METHODS

A total of 439 patients with SCC of the tongue were diagnosed and treated in the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Patients were treated over a 12.5-year period ranging from January 1, 2001 to June 30, 2013. Statistical analysis was performed to examine potential differences between the groups.

RESULTS

The number of patients with a crown and/or a bridge (134, 63.5%) was significantly different than the number of patients without a prosthesis (77, 36.5%). Even after accounting for different types of prostheses such as crowns, bridges, and dentures, no significant differences were observed between the position of the prosthesis and the location of the SCC of the tongue, with significance defined as a P-value less than .05 by the Pearson-Chi square test.

CONCLUSION

Patients with crowns and/or bridges exhibited more frequent SCC of the tongue compared with patients without these prosthesis. These data support the hypothesis that mechanical trauma and galvanic phenomena play a role in the etiology of SCC of the tongue.     

舌肌功能训练对舌后缩的无牙颌患者修复效果的初步研究

目的 观察舌肌的功能训练是否能改善舌后缩的程度并提高下颌全口义齿的固位效果.方法 选择30例舌后缩的无牙颌患者,按照生物功能性修复系统(biofunctional prosthetic system,BPS)的标准流程为其制作全口义齿,并在下颌义齿前牙区唇侧基托的磨光面制作3个底为5 mm、高为2 mm的树脂突,间隔为...     

A rare case of glial choristoma of the tongue associated with cleft palate

Glial choristoma is considered a developmental malformation characterized by brain heterotopias without connection to the central nervous system. In this article, we report a rare case of glial choristoma occurring on the dorsum of the tongue with cleft palate in a 3-month-old male infant. Complete surgical excision was performed prior to palatoplasty. There were no postoperative complications or evidence of recurrence after 5 years of follow-up.     

Panendoscopy and simultaneous primary tumours in patients presenting with early carcinoma of the mobile tongue

Many patients who present with primary malignant disease of the head and neck are examined under anaesthesia to see if they have synchronous tumours. Although previous studies have attempted to establish whether this is either efficient or cost-effective, the patients included tended to include heterogeneous index sites as well as newly-diagnosed and previously-diagnosed tumours. Seventy-four patients who presented with newly-diagnosed early carcinoma of the mobile tongue (T1 N0 / T2 N0) were studied. None had any symptoms of other upper aerodigestive tract disease and all had panendoscopy including bronchoscopy and oesophagoscopy. Only three had serious abnormalities, of which two were synchronous carcinomas. In no patient did the findings of the panendoscopy influence definitive treatment of the index tumour.Although there was no morbidity associated with panendoscopy among these patients, the routine use of panendoscopy we conclude that it is not warranted.     

An ectomesenchymal chondromyxoid tumour on the lateral border of the tongue

Ectomesenchymal chondromyxoid tumour (ECT) is an extremely rare intraoral mesenchymal tumour. Most of these tumours have been identified on the anterior aspect of the dorsal surface of the tongue. ECT is difficult to diagnose because of its rarity. We report a case of ECT arising on the lateral border of the tongue in a 67-year-old woman. The tumour, measuring 20 × 10 mm in size, was surgically removed. Histopathologically, the tumour was composed of small polygonal cells arranged in sheets, with a myxoid or hyalinized stroma. The tumour boundary was clear; however, the tumour showed a multinodular structure expanding along the tongue surface without obvious capsule. Careful examination revealed the tumour nodule to be spreading in a skip lesion-like fashion away from the main part of the tumour in the striated muscle layer. Although there was no evidence of recurrence at 18 months after the surgery, our observations suggest that surgery for ECT resection with a safety margin is more appropriate than enucleation.