Oral squamous cell carcinoma: clinicopathological features from 346 cases from a single Oral Pathology service during an 8-year period

Epidemiological data from oral squamous cell carcinoma (OSCC) is mostly derived from North American, European and East Asian populations.

Objective

The aim of this study was to report the demographic and clinicopathological features from OSCC diagnosed in an Oral Pathology service in southeastern Brazil in an 8-year period.

Material and Methods

All OSCC diagnosed from 2005 to 2012 were reviewed, including histological analysis of all hematoxylin and eosin stained slides and review of all demographic and clinical information from the laboratory records.

Results

A total of 346 OSCC was retrieved and males represented 67% of the sample. Mean age of the patients was 62.3 years-old and females were affected a decade older than males (p<0.001). Mean time of complaint with the tumors was 10 months and site distribution showed that the border of the tongue (37%), alveolar mucosa/gingiva (20%) and floor of mouth/ventral tongue (19%) were the most common affected sites. Mean size of the tumors was 3.4 cm, with no differences for males and females (p=0.091) and males reported both tobacco and alcohol consumption more frequently than females. Histological grade of the tumors revealed that 27%, 40% and 21% of the tumors were, respectively, classified as well-, moderately- and poorly-differentiated OSCC, 26 cases (7.5%) were microinvasive OSCC and 17 cases were OSCC variants. OSCC in males mostly affected the border of tongue, floor of mouth/ventral tongue and alveolar mucosa/gingival, while they were more frequent on the border of tongue, alveolar mucosa/gingival and buccal mucosa/buccal sulcus in females (p=0.004).

Conclusions

The present data reflect the epidemiological characteristics of OSCC diagnosed in a public Oral Pathology laboratory in southeastern Brazil and have highlighted several differences in clinicopathological features when comparing male and female OSCC-affected patients.     

Normal Mouth Opening in an Adult Indian Population

Background

Mouth opening among different population has been shown to vary considerably and its range is specific for a given population. The present study is an attempt to calculate the normal mouth opening in adult Indian population.

Method

A total of 894 adults, 463 males and 431 females, in the age range of 21 to 70 years were studied. The subjects were asked to open their mouth maximally till no further opening was possible. The distance from the incisal edge of the upper incisor teeth to the incisal edge of the lower incisor teeth was measured using a calibrated fiber ruler. To determine correlation of mouth opening with age a Pearson correlation analysis was performed and statistical significance was tested by the application of t test.

Observations

The mean maximal mouth opening for males was 51.3 mm (SD 8.3) (Range 39–70 mm). The mean maximal mouth opening for females was 44.3 mm (SD 6.7) (Range 36–56 mm). There was significant difference between the mouth opening of male and female in all the age groups with P value <0.05. A linear relationship was observed between the mouth opening and age in both males and females and the mouth opening decreased as the age increased.

Conclusion

The mean maximal mouth opening for Indian males is 51.3±8.3 mm and for females is 44.3±6.7 mm. The mouth opening seems to decrease with age. The mouth opening of females is significantly less than the males in all the age groups.     

A double blind randomised trial of IIb or not IIb neck dissections on electromyography, clinical examination, and questionnaire-based outcomes: a feasibility study

The aim of this double-blind randomised controlled trial was to evaluate the feasibility of a study to compare differences using electromyographic (EMG) or nerve conduction studies (NCS), questionnaires completed by patients, and range of movement, after selective supraomohyoid neck dissection in patients with and without level IIb for node-negative oral cancer. Between January 2006 and July 2008 we recruited 57 previously untreated consecutive patients with node-negative T1 or T2 squamous cell carcinomas (SCC) of the anterior two-thirds of the tongue and floor of the mouth. Thirty-eight patients were randomised (32 unilateral and 6 bilateral dissections) into two groups. Preoperatively and at 6 weeks postoperatively we collected EMG or NCS data on trapezius muscle activity (primary outcome), the University of Washington quality of life scale (UWQoLv4), the neck dissection impairment index (NDII), and range of movement. At 6 months data on range of movement and data from the questionnaires were obtained. There was a greater mean fall in trapezius M-response amplitude for those who had IIb dissected, which suggested that inclusion of this level caused additional morbidity. However, it was not significant for patients who had unilateral dissections or for all necks combined. Changes in M-amplitude from baseline to 6 weeks, and from baseline to 6 months were strongly associated with changes in the shoulder domain of the UWQoL and the NDII, but were less strong for change in range of movement. This feasibility study has shown that a randomised controlled trial (RCT) is achievable. The combination of EMG or NCS with questionnaire data preoperatively and to 6 weeks would suffice and would simplify a new study design.     

Bare bone graft with vascularised iliac crest for mandibular reconstruction

Background

“Bare bone graft” with a vascularised iliac crest is a procedure involving no soft tissue for intraoral lining, and the intraoral defect is covered with epithelial cells through secondary healing of the exposed bone.

Methods

A vascularised iliac crest flap is transferred to a segmental mandibular defect intraorally in the position of the osteotomized stump upwardly. Granulation tissue is usually observed on the stump of the bone graft about 1 week after surgery. When sufficient granulation is observed after approximately 4 weeks, “resurfacing” is performed to prevent interference of hypergranulation tissue with epithelization. Resurfacing involves wiping the granulation tissue from the surface of the bone and covering with a plastic prosthesis fitted to the alveolus.

Results

A total of 11 patients underwent bare bone graft with a vascularised iliac crest. Resurfacing was performed at an average of 2.1 times for each patient. All wounds in the oral cavity were completely epithelialized from 2 weeks to 3 months after surgery. Complications with the recipient side occurred in four patients.

Conclusions

Bare bone graft with the iliac crest is one favourable option for mandibular reconstruction utilising the particular shape of the bone without the attached soft tissue.     

102例口腔扁平苔藓临床治疗回顾性分析

目的探讨口腔扁平苔藓的临床特点和治疗方法。方法回顾性分析102例口腔扁平苔藓患者的临床特点、治疗方法及疗效。结果本研究中患者以女性多见,占55.0%;病损部位以颊黏膜多见,占82.4%;多部位病损患者占73.5%。采用局部和全身联合用药方式,充血糜烂型和溃疡型患者口服硫酸羟氯喹片、白芍总苷胶囊,病损区域基底部行醋酸曲安奈德注射液封闭治疗。反复出现糜烂或溃疡且曲安奈德局部封闭无效者给予他克莫司软膏病损处外用。单纯网纹型患者口服白芍总苷胶囊,局部外用维甲酸软膏。所有患者均给予碳酸氢钠溶液含漱和西吡氯铵含片含服。3个月总有效率为79.4%,6个月为86.3%,1年为88.2%。结论根据口腔扁平苔藓的临床特点采用局部和全身联合用药疗法效果较理想。     

Risk Factors for Neurologic Complications of Hand,Foot and Mouth Disease in the Republic of Korea, 2009

In 2009, the first outbreak of hand, foot and mouth disease (HFMD) or herpangina (HP) caused by enterovirus 71 occurred in the Republic of Korea. This study inquired into risk factors associated with complications of HFMD or HP. A retrospective medical records review was conducted on HFMD or HP patients for whom etiologic viruses had been verified in 2009. One hundred sixty-eight patients were examined for this investigation. Eighty patients were without complications while 88 were accompanied by complications, and 2 had expired. Enterovirus 71 subgenotype C4a was the most prevalent in number with 67 cases (54.9%). In the univariate analysis, the disease patterns of HFMD rather than HP, fever longer than 4 days, peak body temperature over 39℃, vomiting, headache, neurologic signs, serum glucose over 100 mg/dL, and having an enterovirus 71 as a causative virus were significant risk factors of the complications. After multiple logistic analysis, headache (Odds ratio [OR], 10.75; P < 0.001) and neurologic signs (OR, 42.76; P < 0.001) were found to be the most significant factors. Early detection and proper management of patients with aforementioned risk factors would be necessary in order to attain a better clinical outcome.     

Studies on the Permeability of Human Oral Mucosa II. The Permeability of Dry Palatal Mucosa to water,Sodium and Potassium

The permeability of normal human palatal mucosa after suspended oral secretion was studied in 14 young adults by analysing the increase of weight and the sodium and potassium content in standardized filter paper discs applied to regions with and without visible glands. Samples taken from mucosa without visible glands exhibited a relatively uniform and individually constant increase in weight, the variation in which proved to be a linear function of the relative humidity of the surrounding air during sampling. Samples taken with direct contact between the mucosa and the filter paper regularly contained small amounts of sodium and potassium, and small amounts of desquamated epithelium. Corresponding samples taken with a cytological filter contained no demonstrable traces of the two electrolytes and showed a strong reduction in the number of epithelial cells. The simultaneous samples from the glandular mucosa region showed greater variability in weight increase and content of the two electrolytes, especially of sodium. The results showed a continuous outward diffusion of water and an apparent impermeability to sodium and potassium of the dry palatal epithelium.     

De-escalation of surgery for early oral cancer – is it oncologically safe?

This study is a review of practice for patients with T1 or T2 squamous cell carcinoma (SCC) of the anterior tongue and floor of the mouth who presented to the regional maxillofacial unit in Liverpool between 1992 and 2007. We examined trends in management and analysed their effects on resection margins, recurrence, and survival. The Liverpool head and neck oncology database was used to identify patients, and to retrieve their clinical, surgical, and pathological data. When data were missing the case notes and pathology records were reviewed. Follow up was taken to January 2011. A total of 382 patients were included. Despite more conservative treatment with closer resection margins (27% in 1992–1995 and 60% in 2004–2007), fewer free flaps (79% in 1992–1995 and 38% in 2004–2007), and less adjuvant radiotherapy (37% in 1992–1995 and 22% in 2004–2007), there has been no significant increase in local recurrence (14% in 1992–1996 and 8% in 2004–2007), and overall survival has not been adversely affected. This is most striking when T1 tumours are considered in isolation with a consistent trend towards fewer clear margins (95% in 1992–1995 and 28% in 2004–2007) and fewer free flaps (53% in 1992–1995 and 11% in 2004–2007). The case mix was similar over the study period. These data support a more conservative approach to the management of early oral cancer.