Effects of Glucose Intolerance on Physiological Accumulation in Salivary Glands and Palatine Tonsils During 18F-Fluorodeoxyglucose Positron Emission Tomography.

PURPOSE:  We evaluated the effects of chronic hyperglycemia on physiological accumulation in salivary glands and tonsils during 18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT). MATERIALS AND METHODS: 12,738 patients underwent whole-body FDG-PET/CT in our institute during the study period. Of these, the case group comprised 777 patients with a blood glucose (BG) level >140 mg/dL; the control group comprised an equal number of randomly selected age- and sex-matched individuals with a BG level <110 mg/dL. Within the case group, the diabetic subgroup was defined as individuals with a BG level >200 mg/dL. Visual assessment and accumulation intensity among tissues were compared between the case and control groups, including (1) the mean difference in maximum standardized uptake value (SUVmax), (2) the difference in the proportion of patients with visible tissues on maximum intensity projection images, and (3) differences between the diabetic subgroup and the control group. RESULTS:  Parotid, submandibular, sublingual, and tonsillar tissues all showed significantly lower SUVmax in the case group than in the control group. The proportions of individuals with visible uptake in the parotid and tonsillar tissues and in the sublingual gland were significantly smaller in the case group than in the control group. Tonsillar uptake was observed in more than 90% of individuals in the control group but in two-thirds of patients in the diabetic subgroup. Accumulation in the parotid and submandibular glands was visible in approximately 80% of individuals in the control group but only half of patients in the diabetic subgroup. CONCLUSION: Physiological accumulation in salivary glands and tonsils is significantly reduced among individuals with hyperglycemia or diabetes.

Disease burden and attributable risk factors of lip and oral cavity cancer in China from 1990 to 2021 and its prediction to 2031.

Aims: This study addresses the essential need for updated information on the burden of lip and oral cavity cancer (LOC) in China for informed healthcare planning. We aim to estimate the temporal trends and the attributable burdens of selected risk factors of LOC in China (1990-2021), and to predict the possible trends (2022-2031). Subject and methods: Analysis was conducted using data from the Global Burden of Disease study (GBD) 2021, encompassing six key metrics: incidence, mortality, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Absolute number and age-standardized rates, alongside 95% uncertainty intervals, were computed. Forecasting of disease burden from 2022 to 2031 was performed using an autoregressive integrated moving average (ARIMA) model. Results: Over the observed period (1990-2021), there were notable increases in the number of deaths (142.2%), incidence (283.7%), prevalence (438.0%), DALYs (109.2%), YLDs (341.2%), and YLLs (105.1%). Age-standardized rates demonstrated notable changes, showing decreases and increases of -5.8, 57.3, 143.7, -8.9%, 85.8%, and - 10.7% in the respective metrics. The substantial majority of LOC burden was observed among individuals aged 40-79 years, and LOC may exhibit a higher burden among males in China. From 2022 to 2031, the age-standardized rate of incidence, prevalence, and YLDs of LOC showed upward trends; while mortality, DALYs, and YLLs showed downward trends, and their estimated values were predicted to change to 2.72, 10.47, 1.11, 1.10, 28.52, and 27.43 per 100,000 in 2031, respectively. Notably, tobacco and high alcohol use emerged as predominant risk factors contributing to the burden of LOC. Conclusion: Between 1990 and 2021, the disability burden from LOC in China increased, while the death burden decreased, and projections suggest these trends will persist over the next decade. A significant portion of this disease burden to modifiable risk factors, specifically tobacco use and excessive alcohol consumption, predominantly affecting males and individuals aged 40-79 years. Attention to these areas is essential for implementing targeted interventions and reducing the impact of LOC in China.

Submandibular Gland Preservation in Oral Cavity Squamous Cell Carcinomas: Our Analysis at A Tertiary Care Hospital.

Introduction: Surgical excision forms the principal treatment of oral cavity squamous cell carcinomas. The comprehensive surgical management consists of Wide Local Excision of the tumor and Neck Dissection with removal of Submandibular gland. The submandibular gland accounts for 70-90 % of unstimulated salivary volume. Its excision as a part of neck dissection has been found to cause high Incidence (21% vs 7%) of postoperative xerostomia. Recent studies have highlighted that the preservation of the SMG is possible and oncologically safe in early-grade OCSCC with N0 neck as the involvement of SMG in such cases is low and its preservation decreases the chances of xerostomia. Materials and Methods: 80 subjects were included in the study to estimate the prevalence of metastatic submandibular gland involvement in oral cavity squamous cell carcinomas. The presence of metastasis into the salivary gland was studied and the mechanism/route of involvement was analysed. The comparison was made between the early and advanced tumors for SMG metastasis irrespective of the primary subsite involvement. Results: In the current study low prevalence (6.2 %) of metastasis to SMG was seen. It was seen in high-grade tumors only. None of the early-grade tumors showed any evidence of SMG metastasis. The most common pattern (80%) of glandular involvement was a direct extension from the primary tumor. Conclusions: Our study concludes that SMG preservation neck dissections can be carried out in early-grade OCSCC irrespective of primary tumor site involvement. The advantages of preserving the SMG are multiple. Furthermore, the morbidity is markedly decreased with its preservation without any compromise on oncological safety.

Achieving negative superficial resection margins with NBI and white light in carcinoma oral cavity: Could it be a norm?

INTRODUCTION: In India, oral cavity cancer rates are the highest, largely due to tobacco and areca nut use. The primary goal of oncologic surgery is complete tumor resection with adequate margins, yet no accepted guidelines exist margin identification. NBI enhances mucosal lesion detection and may improve margin assessment in OSCC. AIMS: This study aims to evaluate the proportion of negative superficial resection margins using NBI and to compare these results with margins assessed using white light (WL) examination. MATERIALS AND METHODS: The study at AIIMS, Rishikesh, included 38 patients with T1-T3 biopsy-proven OSCC. Surgical margins were marked using WL and NBI. Histopathology classified margins as clear (>5mm), close (1-5 mm), or involved. Sensitivity, specificity, and predictive values of NBI were calculated. RESULTS: The average NBI examination duration was 227 s. Negative margins were achieved in 68.42 % (>5mm) and 78.94 % (>3mm) of NBI cases, compared to 71.05 % and 84.21 % for WL. NBI had a sensitivity of 12.50 %, specificity of 96.67 %, and overall accuracy of 78.95 %. DISCUSSION: NBI showed high specificity but low sensitivity. This could be due to the smaller number of patients in NBI positive group. In the present study, the single positive margin identified with NBI could also have been detected with the combined approach of white light and palpation, ensuring that no positive margins were missed. CONCLUSION: NBI can complement WL for margin assessment in oral SCC but requires a long learning curve and a dedicated team. Integrating NBI into standard protocols could improve surgical outcomes and reduce recurrence.

Integrating lymph node ratio into personalized radiotherapy for oral cavity squamous cell carcinoma.

PURPOSE: The use of postoperative radiotherapy (PORT) in patients with oral squamous cell carcinoma (OCSCC) lacks clear boundaries due to the non-negligible toxicity accompanying its remarkable cancer-killing effect. This study aims at validating the ability of deep learning models to develop individualized PORT recommendations for patients with OCSCC and quantifying the impact of patient characteristics on treatment selection. METHODS: Participants were categorized into two groups based on alignment between model-recommended and actual treatment regimens, with their overall survival compared. Inverse probability treatment weighting was used to reduce bias, and a mixed-effects multivariate linear regression illustrated how baseline characteristics influenced PORT selection. RESULTS: 4990 patients with OCSCC met the inclusion criteria. Deep Survival regression with Mixture Effects (DSME) demonstrated the best performance among all the models and National Comprehensive Cancer Network guidelines. The efficacy of PORT is enhanced as the lymph node ratio (LNR) increases. Similar enhancements in efficacy are observed in patients with advanced age, large tumors, multiple positive lymph nodes, tongue involvement, and stage IVA. Early-stage (stage 0-II) OCSCC may safely omit PORT. CONCLUSIONS: This is the first study to incorporate LNR as a tumor character to make personalized recommendations for patients. DSME can effectively identify potential beneficiaries of PORT and provide quantifiable survival benefits.

Contralateral submental artery island flap for oral tongue reconstruction - a retrospective study in patients with oral tongue squamous cell carcinoma.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is a leading cause of cancer-related deaths in developing countries. The oral tongue is the most common site involved by OSCC. About one-third of the patients have neck nodal metastasis at presentation. Oral tongue reconstruction after resection for cancer is necessary for proper rehabilitation. For patients who are medically unfit for prolonged surgery like a free tissue transfer, local flaps are employed for tongue reconstruction. The submental flap is a popular option. However, when there is an extensive floor of mouth involvement or bulky nodal disease in ipsilateral level 1, submental flap harvesting based on contralateral facial vessels is possible without compromising oncological safety. This study discusses the feasibility and outcomes of contralateral submental artery island flap (SMIF) for reconstruction after resection of oral tongue carcinoma in a retrospective series of 34 patients followed up for a median of 8.5 months. RESULTS: Of the 34 oral tongue cancer patients in the study, 16 had neoadjuvant chemotherapy before surgery. Thirty-three underwent bilateral neck dissection. Two patients had partial flap loss, which was managed conservatively. Five patients had either locoregional or distant recurrence, but none in the flap site. Three had pathological positive nodes at ipsilateral level 1b, and one had pathologically positive nodes at contralateral level 1b. Tongue motility and speech intelligibility were satisfactory on follow-up. CONCLUSION: In the properly selected patient, contralateral SMIF offers an oncologically safe and technically simpler alternative for free flap reconstruction.

Oral Cavity Cancer Secondary to Dental Trauma: A Scoping Review.

(1) Background: Oral cavity cancer represents the most common site of origin of head and neck mucosal malignancies. A few limited studies have suggested that chronic irritation, particularly in non-healing ulcers, and fibrotic tissue from poor dentition or ill-fitting dentures had a role in developing mouth cancer. This scoping review aims to evaluate the existing evidence concerning Oral Cavicty Cancer (OCC) in non-smokers/non-drinkers and the relationship with dental trauma. (2) Methods: A scoping review of the PubMed, Embase, and Web of Science databases was completed in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. (3) Results: Of the 33 articles that met inclusion, in 6 of them authors discussed the role of topography in dental trauma, in 11 articles authors discussed the carcinogenesis mechanism involved in chronic mucosal trauma, in 17 articles data on ill-fitting dentures was included, 4 studies dealt with the effect of broken/sharp teeth on mucosal damage, and in 7 studies the role of oral hygiene was covered. Less frequently discussed topics included gender, risk of neck nodes, and the role of potentially malignant oral disorders. (4) Conclusions: The available literature suggests a potential connection between chronic dental trauma and the development of OCC. Studies have highlighted factors such as denture use and ill-fitting dental appliances as contributors to an increased risk of oral cancer. Interestingly, we still miss data to support the hypothesis that women, particularly those without toxic habits like smoking or alcohol consumption, appear to be disproportionately affected by oral cancer related to chronic dental trauma.

The Impact of Oral Microbiome Dysbiosis on the Aetiology, Pathogenesis, and Development of Oral Cancer.

Oral squamous cell carcinoma (OSCC) is the most common head and neck cancer. Although the oral cavity is an easily accessible area for visual examination, the OSCC is more often detected at an advanced stage. The global prevalence of OSCC is around 6%, with increasing trends posing a significant health problem due to the increase in morbidity and mortality. The oral cavity microbiome has been the target of numerous studies, with findings highlighting the significant role of dysbiosis in developing OSCC. Dysbiosis can significantly increase pathobionts (bacteria, viruses, fungi, and parasites) that trigger inflammation through their virulence and pathogenicity factors. In contrast, chronic bacterial inflammation contributes to the development of OSCC. Pathobionts also have other effects, such as the impact on the immune system, which can alter immune responses and contribute to a pro-inflammatory environment. Poor oral hygiene and carbohydrate-rich foods can also increase the risk of developing oral cancer. The risk factors and mechanisms of OSCC development are not yet fully understood and remain a frequent research topic. For this reason, this narrative review concentrates on the issue of dysbiosis as the potential cause of OSCC, as well as the underlying mechanisms involved.

Occupational benzene exposure and risk of head and neck cancer: A systematic review and meta-analysis.

INTRODUCTION: Benzene, an aromatic hydrocarbon, is a well-known leukemogen. To date, the link between benzene exposure and solid cancers is under examination. Our objective is to perform a systematic review and meta-analysis to evaluate if the occupational exposure to benzene is associated with the incidence and mortality of head and neck cancers (HNCs). METHODS: We systematically reviewed the literature for pertinent cohort studies mentioned in the most recent IARC Monograph on benzene working exposure and other cohorts and case-controls identified via a literature search performed in PubMed, Scopus, and Embase, from their inception to March 2024. Stratified multilevel meta-analyses according to study design, cancer type, industrial sector, quality score of the articles, geographic region and risk of exposure bias were conducted. RESULTS: A total of 29 independent studies were included in our review and multilevel meta-analysis. The findings revealed a bordeline association between exposure to occupational benzene and incidence of HNCs RR = 1.27, 95% CI = 1.00-1.64, I2 level2 = 0%, I2level3 = 43.30%, P < 0.05). In addition, we found a significant increased overall risk of HNCs in females (RR = 1.68, 95% CI = 1.07-2.61; I2level2 = 0%, I2level3 = 0%, P = 0.433). Stratification analysis according to cancer sites showed a significant increase in risk of nose & sinuses cancers (RR = 3.72, 95% CI = 2.07-6.68; I2level2 = 34.13%, I2level3 = 0%, P = 0.17). European cohorts (RR = 1.31, 95% CI = 1.08-1.59, p < 0.01) and lower quality studies (RR = 1.39, 95% CI = 1.00-1.91; I2level2 = 0%, I2level3 = 45.94%, P < 0.001). No evidence of publication bias was found (Egger test P = 0.103). CONCLUSIONS: In conclusion, this systematic review and meta-analysis provide evidence that workers with occupational exposure to benzene might be at increased risk of HNCs, in particular for nose & sinuses cancer. However, it is essential to consider the limitations of the studies, particularly residual confounding, and the areas that need further study to improve our understanding of the subject.

Oral Care in Head and Neck Radiotherapy: Proposal for an Oral Hygiene Protocol.

This review aims to provide a comprehensive overview of the literature on the oral side effects caused by radiotherapy for head and neck cancers. Various treatments are examined to mitigate these sequelae, and a protocol is proposed for dentists and dental hygienists to manage oncological patients. A literature search was conducted to select relevant articles addressing the effects of radiotherapy treatments on the oral cavity, with a particular focus on the development of mucositis, candidiasis, changes in salivary pH, trismus, fibrosis, and alterations in the oral biofilm. PubMed and MedLine were used as search engines, with keyword combinations including: head and neck cancer, mucositis, candida, dental care, dental hygiene, epidemiology, oral microbiome, biofilm, trismus, fibrosis, and salivary pH. A total of 226 articles were identified, spanning the period from 1998 to 2023. Articles deemed inappropriate or in languages other than English or Italian were excluded. A management protocol for oncological patients was proposed, divided into two phases: home-based and professional. Despite the advancements in intensity-modulated radiation therapy, it is impossible to completely avoid damage to healthy tissues. Preventive education and counseling in the dental chair, ongoing motivation, and education about oral hygiene are crucial to combine a good therapeutic outcome with an improved quality of life for the patient.

Oral Focal Mucinosis of the Tongue: Case Report and Review of the Literature.

Oral focal mucinosis (OFM) is an oral mucosal lesion characterized by focal mucosal accumulation that rarely occurs on the tongue. This report describes a rare case of OFM on the right side of the tongue in a 71-year-old female patient. The clinical features of OFM have not been well defined, making it difficult to differentiate it from other lesions based solely on clinical manifestations; therefore, histopathological examinations are necessary. Although OFM on the tongue is rare and has a good prognosis with resection, it should be considered as differential for painless mass lesions in the oral cavity.

Multifocal and Recurrent Tonsillar Squamous Cell Carcinoma.

The following study describes a complex clinical course of recurrent and multifocal squamous cell carcinoma (SCC) of the tonsil, involving both initial and subsequent malignancies over several years. The patient, a 54-year-old male with a history of tobacco use, first presented with SCC of the left tonsil, treated with tonsillectomy and neck dissection. Despite clear margins post-surgery, the patient developed SCC in the right tonsil two years later, requiring further surgical intervention and a comprehensive treatment approach. The disease then progressed to the base of the tongue and right larynx, necessitating a total laryngectomy and subtotal glossectomy. The report emphasizes the critical role of advanced imaging and surgical techniques, including robotic-assisted surgery, in managing such complex cases. Additionally, the case highlights the challenges of treating advanced oropharyngeal SCC, the importance of multidisciplinary management, and the need for consistent follow-up to monitor treatment efficacy and manage complications. The case underscores the complexity of SCC in the head and neck region and the necessity for tailored therapeutic strategies to improve patient outcomes.

The state of systemic immunity in congenital cleft lip and palate patients with diseases of oral cavity tissues.

OBJECTIVE: Aim: To determine the state of dental health and the state of systemic immunity in patients in congenital cleft lip and palate patients. PATIENTS AND METHODS: Materials and Methods: The dental status and immunologic tests of 74 patients age 8-18 years old with congenital cleft lip and palate was analyzed: 43 children with unilateral and 31 children with bilateral complete combined cleft lip, alveolar process, hard and soft palate. RESULTS: Results: Indicators of the prevalence and intensity of the caries process in patients with congenital congenital complete cleft lip, alveolar process, hard and soft palate were high, especially in children with bilateral cleft lip and palate - the decompensated course of caries was determined in 41.93% patients, with unilateral - 23.25%. Сhronic catarrhal gingivitis was the most common in both groups of patients - the average severity of gingivitis prevailed - 51.16% with congenital unilateral cleft lip and palate and 51.61% - with bilateral. Atopic cheilitis, glossitis and chronic recurrent aphthous stomatitis were common. This patients have significant changes in the cellular chain of the immune system with a deficiency of the main phenotypes of lymphocytes - CD4+ CD8+ and inflammatory bacterial changes in blood serum. CONCLUSION: Conclusions: Patients of unilateral and bilateral complete combined cleft lip, alveolar process, hard and soft palate have significant changes in the dental status and in the cellular chain of the immune system. The level of manifestation of these changes is directly proportional to the extent of localization of the pathology - unilateral or bilateral.

Hemangioma of the Tongue: A Case Report.

Vascular anomalies include a wide range of tumors and malformations. Hemangioma is the most frequent vascular defect. Hemangiomas are benign endothelial cell tumors most frequently detected in children but uncommon in adults. Most of them affect the neck and head regions but rarely involve the palate, lips, tongue, and buccal mucosa. Treatment for oral hemangiomas should begin as soon as possible because they are clinically significant. Patients are at an increased risk of developing tongue hemangiomas due to the tongue's high flexibility and muscular structure, which makes it more vulnerable to trauma and its effects. They grow and proliferate within a few weeks of birth, with the majority of their components undergoing involution. Females are more likely than males to develop hemangiomas. Hemangiomas are treated with surgery, laser therapy, radiofrequency, sclerosing agents, radiation treatment, cryosurgery, corticosteroids, embolization, electrocauterization, and interferon. When assessing treatment options for hemangiomas, it is crucial to consider various criteria, such as the lesion's hemodynamics, the patient's age, and the location, size, and feasibility of the planned procedure. This report describes a case of a 19-year-old female diagnosed with a hemangioma located on the middle third of the dorsal aspect of the right lateral border of the tongue.

Tumor Bed Margins Versus Specimen Margins in Oral Cavity Cancer: Too Close to Call?

INTRODUCTION: The routine assessment of intraoperative margins has long been the standard of care for oral cavity cancers. However, there is a controversy surrounding the best method for sampling surgical margins. The aim of our study is to determine the precision of a new technique for sampling tumor bed margins (TBMs), to evaluate the impact on survival and the rate of free flap reconstructions. METHODS: This retrospective cohort study involved 156 patients with primary cancer of the tongue or floor of the mouth who underwent surgery as initial curative treatment. Patients were separated into 2 groups: one using an oriented TBM derived from Mohs' technique, where the margins are taken from the tumor bed and identified with Vicryl sutures on both the specimen and the tumor bed, and the other using a specimen margins (SMs) driven technique, where the margins are taken from the specimen after the initial resection. Clinicopathologic features, including margin status, were compared for both groups and correlated with locoregional control. Precision of per-operative TBM sampling method was obtained. RESULTS: A total of 156 patients were included in the study, of which 80 were in TBM group and 76 were in SM group. Precision analysis showed that the oriented TBM technique pertained a 50% sensitivity, 96.6% specificity, 80% positive predictive value, and an 87.5% negative predictive value. Survival analysis revealed nonstatistically significant differences in both local control (86.88% vs 83.50%; P = .81) as well as local-regional control (82.57% vs 72.32%; P = .21). There was a significant difference in the rate of free flap-surgeries between the 2 groups (30% vs 64.5%; P < .001). CONCLUSION: Our described oriented TBM technique has demonstrated reduced risk of free flap reconstructive surgery, increased precision, and similar prognostic in terms of local control, locoregional control, and disease-free survival when compared to the SM method.

Rethinking Surgical Margins: A New Approach to Predict Outcomes in Oral Squamous Cell Carcinoma.

OBJECTIVE: The traditional categorical division of surgical margins using a 5 mm cutoff in oral cavity squamous cell carcinoma (OCSCC) is controversial. The primary aim of this study was to investigate the presence of an optimal cutoff point or, alternatively, assess the potential improvement in predictive value by considering the surgical margins as a continuum. METHODS: Retrospective analysis of OCSCC patients at a tertiary medical center in 1995-2020. Clinical, pathological, and surgical data were evaluated for effect on survivability by regression analyses. RESULTS: The cohort included 266 patients (48.1% male, mean age 65.4 ± 17.7). Patient stratification by categorical margin status yielded no significant between-group differences in survival (p = 0.54). Significance was achieved when margin distance was reevaluated as a continuous variable (p = 0.0018). Similar results were shown in local control (categorical p = 0.59 vs. continuous p = 0.06). Multivariate model excluded possible confounders. A predictive model was created to provide a more accurate prediction of survival. CONCLUSIONS: The continuum spectrum of margin distance better predicts survival outcomes and locoregional control in OCSCC. LEVEL OF EVIDENCE: 3 Laryngoscope, 2024.

Oral microbiota and metabolites: key players in oral health and disorder, and microbiota-based therapies.

The review aimed to investigate the diversity of oral microbiota and its influencing factors, as well as the association of oral microbiota with oral health and the possible effects of dysbiosis and oral disorder. The oral cavity harbors a substantial microbial burden, which is particularly notable compared to other organs within the human body. In usual situations, the microbiota exists in a state of equilibrium; however, when this balance is disturbed, a multitude of complications arise. Dental caries, a prevalent issue in the oral cavity, is primarily caused by the colonization and activity of bacteria, particularly streptococci. Furthermore, this environment also houses other pathogenic bacteria that are associated with the onset of gingival, periapical, and periodontal diseases, as well as oral cancer. Various strategies have been employed to prevent, control, and treat these disorders. Recently, techniques utilizing microbiota, like probiotics, microbiota transplantation, and the replacement of oral pathogens, have caught the eye. This extensive examination seeks to offer a general view of the oral microbiota and their metabolites concerning oral health and disease, and also the resilience of the microbiota, and the techniques used for the prevention, control, and treatment of disorders in this specific area.

Correlation between oral cavity volume and upper airway changes in skeletal Class III patients undergoing bimaxillary orthognathic surgery: a pilot cone-beam computed tomography study.

OBJECTIVES: To evaluate changes of the upper airway and oral cavity volumes in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery, and to analyze the correlation between postoperative upper airway decrease and the amount of jaw movement and oral cavity volume reduction. MATERIALS AND METHODS: Thirty patients (16 males and 14 females) undergoing bimaxillary surgery were included. Three-dimensional reconstruction of the upper airway and oral cavity were performed using preoperative (T0) and postoperative (T1) (6 months) cone-beam computed tomography scans. RESULTS: The volume, sagittal area and minimum cross-sectional area of the upper airway were diminished (P < .001). The decrease in volume and minimum cross-sectional area in the oropharyngeal region of the upper airway were weakly correlated with B-point posterior movement (P < .05). Total oral cavity volume was decreased, with maxillary oral volume increasing and mandibular oral volume decreasing (P < .001). Upper airway decrease was highly correlated with total oral volume reduction and mandibular oral volume reduction, with the most significant correlation being with total oral volume reduction (P < .001). CONCLUSIONS: Class III bimaxillary surgery reduced the volume, sagittal area, and minimum cross-sectional area of the upper airway as well as oral cavity volume. Upper airway changes were weakly correlated with anterior-posterior mandibular movement but significantly correlated with oral cavity volume changes. Thus, oral cavity volume reduction is a crucial factor of upper airway decrease in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery.

Variant of internal jugular vein reconstruction in bilateral radical neck dissection.

BACKGROUND: The internal jugular vein (IJV) plays a major role in collecting venous blood from the cranium, face, and neck. Preserving or reconstructing at least one IJV during bilateral radical neck dissection (RND) allows preventing severe complications. The aim of this report was to present a variant of IJV reconstruction in bilateral radical neck dissection. CASE SUMMARY: A 55-year-old male complained for a gingival mass for about 2 months, which was approximately 4 × 2 cm in size with a surface ulceration, located in the anterior mandibular area. There were bilateral cervical adenopathy. The computed tomography (CT) scan revealed mandibular bone destruction with surrounding soft tissue masse, multiple enlarged lymph nodes around bilateral submandibular space and bilateral carotid sheath, with obvious necrosis in the center. The preoperative diagnosis was mandibular gingiva squamous cell carcinoma (SCC), staged T4aN2bM0. Under general anesthesia, the patient underwent bilateral RND with sacrifice of right IJV and reconstruction of left IJV by anastomosis of IJV to the ipsilateral EJV using the common facial vein as a communicating way, followed by an expanded resection of mandibular gingiva SCC via marginal mandibulectomy, left anterolateral thigh (ALT) free flap reconstruction of the resulting defects, and tracheotomy. The patient's post-operative course was uneventfully. CONCLUSION: In our case report, the immediate IJV reconstruction by the W method was performed without compromising oncologic principles and was found feasible, safe and effective to prevent the occurrence of severe postoperative complications related to bilateral RND with sacrifice of both IJV.