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Tongue cancers are common in the spectrum of oral malignancies. In base of tongue cancers, tumour excision might lead to injury of ipsilateral or both lingual arteries, leading to ischemia of residual, native tongue. Free radial artery forearm flap is commonly used for tongue reconstruction. It can also be used as a flow-through flap for the reconstruction of the tongue defect as well as to revascularise the cancer-free tongue remnant. We report here two cases of base of tongue excision for which free flow-through radial forearm flap was used to reconstruct the tongue defect as well as salvage the remaining part of ischemic tongue. This technique can be effectively considered in selected cases of vascular compromise due to lingual vessel sacrifice to preserve the cancer-free anterior native tongue tissue with improved functional outcomes.
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Introducción: las neoplasias malignas en cavidad oral representan de 3-5% de todas las neoplasias, el carcinoma de células escamosas representa 90%, es la neoplasia más frecuente. Objetivo: identificar la frecuencia de neoplasias malignas diagnosticadas histopatológicamente en 2,042 casos consecutivos en la cavidad oral, en un servicio patológico privado, clasificándolas por edad, sexo y localización. Material y métodos: estudio transversal de un muestreo por conveniencia en un periodo que data de enero de 2017 a diciembre de 2018. Resultados: la prevalencia de neoplasias malignas fue de 6.06% (124/2042). Conclusiones: las neoplasias malignas afectan principalmente a personas mayores de 40 años con predilección por el sexo masculino, probablemente porque las mujeres acuden con mayor frecuencia a evaluaciones médicas (AU)
Introduction: malignant neoplasms in oral cavity represent 3 to 5% of all the neoplasms where squamous cell carcinoma is the most frequent with a representation rate of 90%. Objective: identify the frequency of malignant neoplasms diagnosed histopathologically in 2,042 consecutive cases in the oral cavity in a private oral pathology service, classifying them by age, sex and location. Material and methods: cross-sectional study of a sampling for convenience from the periods of January 2017 to December 2018. Results: the prevalence of malignant neoplasms was 6.06% (124/2042). Conclusions: malignant neoplasms mainly affect people over 40; with a predilection for the male sex, probably because women attend medical evaluations more frequently (AU)
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias de la Boca/diagnóstico , Neoplasias de la Boca/epidemiología , Carcinoma de Células Escamosas/epidemiología , Interpretación Estadística de Datos , Factores de Edad , Distribución por Edad y Sexo , Hospitales Militares/estadística & datos numéricos , México/epidemiologíaRESUMEN
It is of interest to evaluate NOTCH1, CD44, BMI1, and TP53 genes in the epiglottis, tongue, and hard palate of oral malignancies (OM) with healthy controls. This was a prospective and cross-sectional study of 60 individuals with oral malignancies (OM) (20 each of tongue, epiglottis, and hard palate) studied at Malla Reddy Medical College and tertiary care hospitals in Hyderabad. Adults aged ≥ 18 years and diagnosed with oral cancer were included in the study. Those who had cancer in more than one area were excluded from the study. Blood samples of individuals with tongue or epiglottis or hard palate were taken for testing the expression of NOTCH1, CD44, TP53, and BMI1 genes. They were analysed by the genomic sequencing method. One-way ANOVA with Bonferroni's t-test was used for statistical analysis. Expression of NOTCH1, CD44, BMI1, and TP53 genes were significantly higher in epiglottis, tongue, and hard palate compared to healthy control samples (p < 0.001). All four genes were expressed in all three areas of OM. However, they were not significant between them. Further analysis revealed that NOTCH1, CD44, TP53, and BMI1 genes did not show any difference in HPV-positive and HPV-negative samples. Comparing the T stages of cancer Notch1, gene expression was significantly higher in stages 1 and 2 compared to 3 and 4. The CD44, TP53, and BMI1 did not show any differences in the T stage. However, the difference in HPV in all T stages was very minimal. Data showed that irrespective of the areas of cancer (epiglottis, tongue, and hard palate) NOTCH1, CD44, TP53, and BMI1 genes were expressed equally. The expression was not very much dependent on HPV positive (+ve) or negative (-ve). However the T-stage was showing higher expression compared to control group. Since the expression of these genes was very high in all the three malignancies, they may be used as early biomarkers to detect cancer of epiglottis, tongue, and hard palate.
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OBJECTIVE: To undertake a comprehensive review of the current knowledge and understanding of autophagy in oral squamous cell carcinoma (OSCC), focusing on putative roles in tumour suppression and survival along with the influence of this cell death pathway on the development of resistance to chemotherapeutic treatment. DESIGN: Several well utilised databases (PubMed, Medline, Google Scholar) were searched for the relevant literature using terms and keywords including but not limited too; autophagy and cancer, autophagy and OSCC, tumour survival, autophagy and oral microbiome, autophagy immunogenicity, OSCC chemoresistance. RESULTS: Up-regulation of autophagy has been shown to promote tumour cell survival in the tumour microenvironment while in healthy cells, autophagy induction acts to prevent severe DNA mutations that can lead to cancer. Cancers utilise the autophagy pathway to promote survival during the stress of chemotherapeutic treatment and can induce resistance to chemotherapeutic drugs CONCLUSION: The ambiguous role of autophagy within cancers is still problematic in clinical fields. Within OSCC understanding whether autophagy plays a preventive or causative role is essential and may be beneficial in determining how modulation of this pathway may impact on OSSC and oral cancer patients.
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Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Autofagia , Línea Celular Tumoral , Humanos , Carcinoma de Células Escamosas de Cabeza y Cuello , Microambiente TumoralRESUMEN
BACKGROUND: Clinical opportunistic screening can be valuable for diagnosis of oral cancer/precancer prior to development of symptoms. Thus, the aim of the present study is to assess the knowledge, perceptions, and present practices of primary health care providers regarding oral cancer screening. MATERIAL AND METHODS: This cross-sectional questionnaire study was carried out on doctors working in primary health centres of Patna district, Bihar. A total of 10 questions in true/false or multiple choice format assessed the knowledge on oral cancer screening. Attitude and practices were evaluated by seven questions each on a 5-point Likert scale. Unpaired t-test and one-way ANOVA followed by post hoc test was applied to determine the significance difference between the mean scores of knowledge and demographic variables. The significance level was set at below 0.05. RESULTS: The total mean knowledge scores were 6.5 ± 2.17. Response analysis showed that regarding opinion on only 28% health care providers agreed or strongly agreed that they have adequate knowledge regarding detection of oral cancer. It was found that 44.7% never/rarely examined the oral cavity of the patient. Only 14% and 16% doctors aid with the cessation of habits and advised dietary changes in patients with precancerous lesions/conditions, respectively. CONCLUSION: Capacity building of primary care physicians is very crucial for a successful screening program. The present study reveals that the training activities of healthcare providers in oral screening need to be reinforced.
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OBJECTIVE: The submental flap can be utilized for soft tissue reconstruction in oral cavity malignancies because due to its close approximation to the surgical site, fewer donor site morbidity and the cost effectiveness of the procedure. METHODS: A total of 30 patients with squamous cell carcinoma of the oral cavity were included in the study from July 2012 to August 2015 in a tertiary care referral hospital. Patients with clinical staging I/II/III (T1/T2/T3, N0) oral malignancy were included in the study. Patients with nodal metastasis irrespective of the stage of disease and patients with chronic medical illness/revision cases were excluded from the study. Submental island flap was utilized for the reconstruction of the soft tissue defect in each patient. Patients were followed at monthly interval till 6 months in the postoperative period. RESULTS: The buccal mucosa (12 patients), tongue (10 patients) and floor of mouth (8 patients) were the subsites in the oral cavity. Partial and complete skin necrosis was found in 4 and 2 patients respectively. Postoperative chemoradiation was required in 5 patients. None of the patients had loco regional recurrence till 6 months of follow-up. CONCLUSION: The submental island flap is considered to be the reliable option for the soft tissue reconstruction in oral cancer because of dependent vascular pedicle, less donor site morbidity and the lower cost compared to the free flaps, often preferred in patients with a lower socioeconomic condition.
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Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) or Autoimmune polyendocrine syndrome type-1 (APS-1) (APECED, OMIM 240300) is a rare, childhood onset, monogenic disease caused by mutations in the Autoimmune Regulator (AIRE) gene. The overall mortality is increased compared to the general population and a major cause of death includes malignant diseases, especially oral and esophageal cancers. We here present a case series of four APS-1 patients with oral tongue cancers, an entity not described in detail previously. Scrutiny of history and clinical phenotypes indicate that chronic mucocutaneous candidiasis and smoking are significant risk factors. Preventive measures and early diagnosis are important to successfully manage this potentially fatal disease.
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BACKGROUND: Oral cancer is the most common type of cancer occurring in India and it is equally important to assess morbidities after treatment for optimal utilization of resources. Utilizing PSS HN we try to identify the patient population who are severely impaired and need aggressive rehabilitation. METHOD AND MATERIAL: The PSSHN questionnaire was administered by the treating physician to 100 consecutive oral cancer patients who completed their index treatment at least 6 months prior to accrual. Functional morbidities with score ≤50 were considered as significant. RESULTS: Prevalence of functional deficit of eating in public; deficit of understandability of speech and deficit of normalcy of diet were 28, 13 and 38 % respectively. CONCLUSION: Type of resection either segmental mandibulectomy or major glossectomy, had most significant impact on concerned functional deficits and surgeries involving these defects should be carefully planned to involve free flap reconstruction and proper postoperative rehabilitation.
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In vivo staining reveals cytological details that might otherwise not be apparent. The aim of the study was to test the utility of toluidine blue test in detecting various types of malignant and premalignant lesions in early stage. Fifty patients with lesion in oral cavity having suspicion of malignancy clinically were selected. After subjecting the patients to clinical examination, the suspicious lesions were stained with 1 % toluidine blue. The biopsy site was selected on the basis of clinical appearance and dye retention and in the sites where no retention of the stain occurred, clinical judgment directed the biopsy site. The sensitivity of toluidine blue in detecting premalignant or malignant lesions was found to be 97.8 % and the over all specificity was found to be 100 %. The positive predictive value, negative predictive value and diagnostic accuracy was reported to be 100, 80 and 90 % respectively. Toluidine Blue staining is highly a reliable source for the detection of insitu and invasive carcinomas. Staining with this stains is an adjunct to clinical judgment, assist in the choice of biopsy site, follow up of premalignant lesions and marginal demarcation of the malignant lesions enabling an intervention method to be adopted earlier for the disease, which carries a high rate of morbidity and mortality.
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AIMS: The present study was under taken to evaluate the efficacy of various local and regional soft tissue flaps used for reconstruction after excision of various malignant lesions of the mouth and also to evaluate complications with length of hospital stay after the reconstruction. MATERIALS AND METHODS: The study was a record based retrospective analysis of 127 patients who were histologically proven squamous cell carcinoma of the oral cavity for which excision of the lesion along with segmental mandibulectomy and primary reconstruction with local or regional flaps was the treatment modality. RESULTS: The male:female mean age is 48.27:48.79. The Z-proportionality test for intra oral reconstruction showed 5% level of significance (P < 0.05) between pectoralis major myocutaneous flap (PMMC) and other flaps. Difference between deltopectoral (DP) and PMMC, PMMC and primary closure at 1% level of significance, i.e. P < 0.01 was found for extra oral defects. The mean stay was found to be 31.31 days. Recurrence rate of 11% was reported. CONCLUSION: A total of 127 patients formed the study group. In the absence of bone reconstruction PMMC still continues to be the "work horse" of reconstruction following wide excision and hemimandibulectomy.