Association of lymph vessel density with occult lymph node metastasis and prognosis in oral squamous cell carcinoma.

BACKGROUND: The aims of this study were to determine intra (ILVD) and peritumoral (PLVD) lymphatic vessel density (LVD), and to investigate the relationship of LVD with occult metastasis and prognosis. METHODS: Eighty-seven oral squamous cell carcinomas, in clinical stages I or II, arising in the tongue or floor of the mouth were stained with podoplanin. Lymphatic vessels were quantified in intra and peritumoral areas by sequential analysis and hot spot evaluation. Associations of the ILVD and PLVD with clinicopathologic parameters were determined by Chi-square or Fisher's exact test. The 5 and 10-year survival rates were calculated by the Kaplan-Meier and compared using the log-rank test. RESULTS: No significant association was observed between ILVD or PLDV and clinicopathologic variables including occult lymph node metastasis, or clinical follow-up. However, ILVD showed a significant association with regional recurrence (p = 0.040). The perineural invasion was associated with PLVD (p = 0.041). Disease-specific (p = 0.044) and disease-free survivals (p = 0.016) had significant association with PLVD. CONCLUSIONS: The intra or peritumoral lymphatic vessel density had no predictive value for occult lymph node metastasis in the early stages of oral cancer arising in the tongue or floor of mouth.

A decreased peritumoral CD1a+ cell number predicts a worse prognosis in oral squamous cell carcinoma.

AIMS: Dendritic cells (DCs) are known to play a central role in the regulation of both innate and adaptive immunological responses, including antitumour immunity. The aim of this study was to evaluate the prognostic impact of intratumoral and peritumoral DCs in oral squamous cell carcinoma (OSCC) affecting the tongue and floor of the mouth. METHODS AND RESULTS: Immunohistochemistry for CD1a and CD83 was performed in 53 patients with OSCC in the tongue and floor of the mouth. The markers were evaluated by automated examination in intratumoral and peritumoral compartments, and the results were expressed as density of cells/mm2 . Correlations between these data and clinicopathological and survival outcomes were investigated. Depletion of peritumoral CD1a+ cells was associated with lymph node metastasis (P = 0.05), whereas depletion of peritumoral CD83+ cells was correlated with smoking history (P = 0.04), lymph node metastasis (P = 0.015), and extracapsular spread of lymph nodes (P = 0.018). Peritumoral CD1a+ was correlated with recurrence (P = 0.007) and overall survival (P = 0.03). The results of the survival analysis with the Cox proportional hazard model showed that depletion of peritumoral CD1a+ cells is an independent factor associated with overall survival and disease-free survival. CONCLUSION: Our results suggest that depletion of peritumoral CD1a+ cells is a strong independent prognostic factor, predicting a higher recurrence rates and worse survival outcomes.

Primary Management of Operable Locally Advanced Oral Cavity Squamous Cell Carcinoma: Current Concepts and Strategies.

INTRODUCTION: Locally advanced oral cavity carcinoma (LAOCSCC) is primarily treated with surgery followed by radiotherapy with or without chemotherapy. METHODS: A review of literature using PubMED was performed for studies reporting the management of LAOCSCC. Based on the reviewed literature and opinions of experts in the field, recommendations were made. RESULTS: Studies have shown that outcomes following resection of T4a and infranotch (inferior to mandibular notch) T4b are comparable. We discuss the concept of compartmental resection of LAOCSCC and issues concerning the management of the neck. Further, patients who refuse or are unable to undergo surgery can be treated with chemoradiotherapy with uncertain outcomes. The role of neoadjuvant chemotherapy has shown promise for organ (mandibular) preservation in a select subset of patients. CONCLUSION: The management strategy for LAOCSCC should be determined in a multidisciplinary setting with emphasis on tumor control, functional preservation, and quality of life of the patient.

Trismus and oral health conditions during diagnosis of malignant oral neoplasms.

INTRODUCTION: Trismus has been considered a late complication of cancer treatment. It can occur prior to treatment, mainly caused by tumor invasion or muscle spasms induced by the presence of the tumor. OBJECTIVE: In this study, we evaluated the incidence of trismus and its effect on oral health in patients with malignant neoplasms of the oral cavity before performing the cancer treatment. METHODS: This review was carried out via interviews, visual clinical inspection and objective measurement of maximal mouth opening in 35 consecutive patients. Trismus was defined as a maximal mouth opening <35mm. RESULTS: Trismus was observed in 15 patients, with a total incidence of 42%. A high rate of tooth loss was recorded, and trismus association with tooth loss was statistically verified using the Chi-square and Fisher's exact tests, the t-student test and Mann-Whitney non-parametric test. All tests were performed at p<0.05. CONCLUSION: Edentulous patients are eight times more likely to have trismus compared to patients that are partially and fully dentate. Trismus was demonstrated to be correlated with tooth loss; however other oral health conditions were not shown to be a modifying factor.

COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice.

The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities. There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists. Health workers represent between 3.8% and 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter). All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55 to 65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases, and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Health care facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for patients with cancer. For those who are working with COVID-19 infected patients' isolation is compulsory in the following settings: (a) unprotected close contact with COVID-19 pneumonia patients; (b) onset of fever, cough, shortness of breath, and other symptoms (gastrointestinal complaints, anosmia, and dysgeusia have been reported in a minority of cases). For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves. The procedures described are essential in trying to maintain safety of health care workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.

Classification of GLOSSECTOMIES: Proposal for tongue cancer resections.

BACKGROUND: Surgery of tongue tumors includes different procedures ranging from mucosal resection to complex combined resection. Numerous terms have been used to describe such procedures, but there is no consensus between the terminology and the extent of resection. METHODS AND RESULTS: We searched the medical literature and found a lack of published information. We undertook to describe a new classification of surgical procedures for tongue tumor resection. We based it upon the surgical anatomy of the tongue and the spread of the cancer. We posited that there were five major types of glossectomy embracing all the methods of tongue cancer resection. This classification was reviewed and endorsed by an international team of experts. CONCLUSION: We propose a more precise classification than that currently in practice, thereby bringing clarity and consistency to the terminology, facilitating shared communication between surgeons, comparison between published research, and ultimately improving surgical practice and patient care.

Oral health, hygiene practices and oral cancer.

OBJECTIVE: To assess the association between oral health and hygiene practices and oral cancer. METHODS: Hospital-based case-control study in the metropolitan area of São Paulo, southeastern Brazil, from 1998 to 2002. A total 309 patients with squamous cell carcinoma of the mouth and the pharynx and 468 controls matched by sex and age were included in the study. Cases were recruited in seven reference hospitals and controls were selected in five out of the seven participating hospitals. Detailed information on smoking, alcohol consumption, schooling, oral health status and hygiene practices were obtained through interviews. Odds ratios (OR) and 95% confidence intervals (95% CI), adjusted by sex, age, schooling, smoking, alcohol consumption as well as the variables oral health status and hygiene practices were estimated using unconditional logistic regression analyses. RESULTS: The use of complete dental prosthesis was not associated with oral cancer but regular gum bleeding showed a strong association (OR 3.1; 95% CI 1.2-7.9). Those who never attended a dental visit were more likely to have oral cancer (OR 2.5; 95% CI 1.3-4.8). Daily mouthwash use showed a stronger association to pharynx (OR 4.7; 95% CI 1.8-12.5) than mouth cancer (OR 3.2; 95% CI 1.6-6.3). CONCLUSIONS: Gum bleeding, no dental care, and daily mouthwash use were factors associated with oral cancer regardless of tobacco and alcohol consumption.

Trismus and oral health conditions during diagnosis of malignant oral neoplasms / Trismo e condições de saúde bucal no diagnóstico de neoplasias malignas da cavidadeoral

Abstract Introduction: Trismus has been considered a late complication of cancer treatment. It can occur prior to treatment, mainly caused by tumor invasion or muscle spasms induced by the presence of the tumor. Objective: In this study, we evaluated the incidence of trismus and its effect on oral health in patients with malignant neoplasms of the oral cavity before performing the cancer treatment. Methods: This review was carried out via interviews, visual clinical inspection and objective measurement of maximal mouth opening in 35 consecutive patients. Trismus was defined as a maximal mouth opening <35 mm. Results: Trismus was observed in 15 patients, with a total incidence of 42%. A high rate of tooth loss was recorded, and trismus association with tooth loss was statistically verified using the Chi-square and Fisher's exact tests, the t-student test and Mann-Whitney non-parametric test. All tests were performed at p < 0.05. Conclusion: Edentulous patients are eight times more likely to have trismus compared to patients that are partially and fully dentate. Trismus was demonstrated to be correlated with tooth loss; however other oral health conditions were not shown to be a modifying factor.

Resumo Introdução: O trismo tem sido considerado uma complicação tardia do tratamento do câncer, pode ocorrer antes do tratamento, causado principalmente por invasão tumoral ou espasmos musculares induzidos pela presença do tumor. Objetivo: Avaliar a incidência do trismo e seu efeito sobre a saúde bucal em pacientes com neoplasias malignas da cavidade bucal antes de se submeterem ao tratamento do câncer. Método: Esta revisão foi realizada por meio de entrevistas, inspeção clínica visual e mensuração objetiva da abertura bucal máxima em 35 pacientes consecutivos. O trismo foi definido como abertura bucal máxima < 35 mm. Resultados: O trismo foi observado em 15 pacientes, com uma incidência de 42%. Uma alta taxa de perda dentária foi registrada e a associação do trismo com a perda dentária foi verificada estatisticamente com os testes qui-quadrado, exato de Fisher, t de Student e não paramétrico de Mann-Whitney. Todos os testes foram realizada com p < 0,05. Conclusão: Pacientes edêntulos são oito vezes mais propensos a ter trismo do que os pacientes parcial e totalmente dentados. O trismo demonstrou estar correlacionado com a perda dentária. Entretanto, as outras condições de saúde bucal não se mostraram um fator modificador.

Total glossectomy in the organ preservation era.

PURPOSE OF REVIEW: Total or subtotal glossectomy is considered a highly morbid procedure. However, in some institutions and in selected cases of unsuccessful chemoradiation regimens, it is performed with acceptable oncological and functional outcomes. RECENT FINDINGS: Chemoradiation for advanced oral and oropharyngeal cancers is also highly morbid and some authors reported reasonable functional results after major glossectomies. Also, there is a lack of prospective trials comparing the long-term outcome between chemoradiation and major glossectomies. SUMMARY: Total and/or subtotal glossectomies with immediate reconstruction can be performed in highly selected patients with advanced oral or base of the tongue carcinomas, as a primary or salvage procedure, with acceptable outcomes.

Modern reconstruction techniques for oral and pharyngeal defects after tumor resection.

Several techniques have been developed to reconstruct oral and pharyngeal defects following surgery, in order to restore function and cosmesis. These are primary closure, skin grafts, local transposition of skin, mucosa and/or muscle, regional flaps and free vascularized flaps. Because of the 'bulky', pedicled nature and problems with the donor area of locoregional flaps, and consequently frequently unsatisfactory functional results, free vascularized flaps have gained popularity during the last decade. The authors review the current options available to give physicians, who are not experienced in the field of reconstruction in the head and neck, an impression of the range of techniques available for reconstruction of oral and pharyngeal defects following tumor resection. For reconstruction of oral cavity and pharyngeal defects, fasciocutaneous (e.g. radial forearm and anterolateral thigh flaps) and myocutaneous free flaps (e.g. rectus abdominis and latissimus dorsi) have proven to be very reliable. Free vascularized osteocutaneous flaps (e.g. fibula and iliac crest) permit reconstructive options for bony defects of the mandible or maxilla that can be adapted to a variety of defects. Depending on the site, size and involved tissues of the surgical defect and patient factors, a variety of reconstructive options are available. For both soft tissue and bony defects of the upper aerodigestive tract, microvascular free flaps provide good functional outcomes.

Oral health, hygiene practices and oral cancer

OBJETIVO: Avaliar a associação entre saúde e higiene bucal na ocorrência de câncer oral. MÉTODOS: Estudo caso-controle de base hospitalar, realizado entre 1998 e 2002 na área metropolitana de São Paulo, SP. Foram incluídos 309 pacientes com carcinoma epidermóide de boca e orofaringe e 468 controles, pareados com os casos por sexo e idade. Os casos foram levantados em sete hospitais que concentram a assistência médica a pacientes com a doença e os controles rastreados em cinco hospitais gerais dentre os sete. Informações pormenorizadas sobre tabagismo, consumo de álcool, escolaridade, saúde bucal e práticas de higiene bucal foram obtidas por entrevista. Por meio de análise de regressão logística não condicional foram calculados odds ratios (OR) e intervalos com 95 por cento de confiança (IC 95 por cento), ajustados por sexo, idade, nível educacional, tabagismo e consumo de álcool, bem como para as demais variáveis de saúde e higiene bucal. RESULTADOS: Uso de prótese bucal total não se associou a câncer oral, mas sangramento gengival freqüente apresentou alta associação (OR=3,1; IC 95 por cento: 1,2;7,9). Nunca ter consultado dentista mostrou associação com câncer oral (OR=2,5; IC 95 por cento: 1,3;4,8). Uso diário de enxaguatórios bucais apresentou associação mais intensa com tumores de faringe (OR=4,7; IC 95 por cento: 1,8;12,5) do que com tumores de boca (OR=3,2; IC 95 por cento: 1,6;6,3). CONCLUSÕES: Sangramento gengival, ausência de consultas com dentistas e uso regular de enxaguatórios bucais foram fatores associados com câncer oral, independentemente de tabagismo e consumo de bebidas alcoólicas.

Treatment planning, total rehabilitation and quality of life of the head and neck cancer patient

Head and neck cancers are devastating diseases for which there are numerous therapeutic options that will result in a high cure rate, but with significant physical and psychosocial sequelae. The ultimate goal of treatment is disease eradication an rehabilitation of physiological, psychological and social status. To achieve this objective it is necessary to avoid fragmented care. Good medical care involves a concerted effort of several medical disciplines, as well as collaboration of dentists, speech therapists, physiotherapists, psychologists, nurses, nutrition specialists and social workers. The rehabilitation program should start when cancer treatment is planned. With the increase in rehabilitation measures and consequent decrease in morbidity the improvement in the quality of life of the head and neck cancer patient becomes a realistic possibility. Several developments in plastic surgery (myocutaneous flaps, microsurgery) and maxillofacial prosthesis have resulted in great improvement in function and cosmetic appearance. Self concept, self-esteem, and body image immediately follow survival in order of in importance. The patient's self-image is crucial for his/her reintegration and adaptation to family, social life and work. Several recent publications have introduced quality of life parameters as an integral part of the evaluation process in clinical practice. The quality of life concept in the health sciences is used to describe aspects of health status as physical symptoms, daily activity level, psychological well-being, and social functioning. Finally, some highlights of the quality of life measurement are reviewed.

Pleomorphic Adenoma of the Submandibular Gland - Clinicopathological and Immunohistochemical Features of 60 Cases in Brazil / Adenoma pleomórfico da glândula submandibular. Características clinicopatológicas e imunohistoquimicas de 60 casos no Brasil

The submandibular gland is involved in only 5 percent to 10 percent of the salivary gland tumors, and pleomorphic adenoma (PA) is the most common tumor affecting it. This study describes the clinicopathological features and immunohistochemical expression of Ki-67 and p53 in 60 cases of submandibular salivary gland PAs. Most of the patients were in the third and fifth decades of life and 37 (62percent) of them were women. Tumor sizes varied from 1 to 10 cm and the mean time between symptom onset and treatment was 52 months. Only 1 patient experienced local recurrence, 3 years after treatment. Histologically, most tumors consisted chiefly in a chondromyxoid stroma. Stroma-rich PAs were larger than stroma-poor ones (P<.02). All PAs were found negative for Ki-67 and p53. These results show that PAs of the submandibular gland are histologically similar to PAs of other salivary glands, and that they have a low proliferative rate and a good prognosis

Multivariate analysis of risk factors for neck metastases in surgically treated parotid carcinomas / Análise multivariada de fatores de risco para metástase de pescoço em cirurgicamente tratadas carcinomas parótidas

Objective: To analyze risk factors for neck metastases in patients with parotid carcinomas. Design: Cohort of patients followed up from 1 to 366.2 months at a single institution Setting: Referral center, private or institutional practice, hospitalized care. Patients: A total of 145 patients with parotid carcinomas with complete clinical and pathological information. The histological diagnosis was reviewed according to the Word Health Organization classification for salivary gland tumors. Intervention: Patients were treated by surgery alone (62 cases) or with postoperative radiotherapy (83 cases). A neck dissection was performed in 80 patients. Main Outcome Measure: Rates of neck lymph node metastasis. Univariate and multivariate analyses were caried out using logistic regression evaluating the significance of demographic, clinical, and pathological data. Results: The following variables were significantly associated to the risk of lymph mode metastasis by univariate analysis: histological type (P<.001), facial palsy (P=.02), perineural invasion (P=.01), extraparotid tumor extension (P=.02) and necrosis (P=.003). By multivariate analysis, histological type (P<.001), T stage (P=.03), and desmoplasia (P=.006) had the highest correlation with lymph node metastasis. Conclusion: The significant risk factors for neck metastasis in parotid carcinoma were histological type (ie, adenocarcinoma, undifferentiated carcinoma, high-grade mucoepidermoid carcinoma, squamous cell carcinoma, and salivary duct carcinoma), T stage (T3 and T4), and desmoplasia (severe)

Risk factors for oral cancer in Brazil: a case-control study

A case-control study of risk factors for carcinomas of the tongue, gum, floor, and other specified parts of the mouth was conduced in three metropolitan areas in Brazil; Säo Paulo (Southeast), Curitiba (South), and Goiânia (Central-West). We analyzed information on demographics, occupational history, environmental exposures, tabacco smoking and alcohol drinking habits, diet, oral and other health characteristics obtained from interviews with 232 cases and 464 hospital non-cancer controls matched on 5-year age group, sex hospital catchment area, and trimester of admission. Tobacco and alcohol consuption were the strongest risk factors irrespective of the anatomical site. The adjusted relative risks (RR) for ever vs. never smokers were: 6.3, 13.9, and 7.00, for industrial-brand cigarrettes, pipe and hand-rolled cigarrettes, respectively. A strong correlation was seen between number of pack-years and risk. The RR for the heaviest vs. the lowest consumption categories (>100 vs. <1 pack-years) was 14.8 Risk levels generally decreased to that of never smokers after 10 years since smoking cessation. The risk associated with alcohol was mostly evident for wine (cancer of the tongue) and "cachaça" (all sites), a hard liquor distilled from sugar cane. Other important risk factors were "chimarräo" drinking (a type of mate), use of a wood stove for cooking, and frequent consumption of charcoal-grilled meat and manioc. Oral hygiene chacarcteristics represented correlates of disease risk