Prognostic value of a mandibular canal staging system for primary lesions in patients with lower gingival squamous cell carcinoma: a multicenter, retrospective study.

BACKGROUND: The Union for International Cancer Control and American Joint Committee on Cancer tumor staging system is used globally for treatment planning. As it may be insufficient for tumor staging of lower gingival carcinomas, we proposed the mandibular canal tumor staging system. In this study, we aimed to compare the two systems for such tumor staging and to identify prognostic markers. METHODS: This multicenter, retrospective study included patients with lower gingival squamous cell carcinoma who underwent radical surgery during 2001-2018. We compared survival rates (Kaplan-Meier estimator) and patient stratification according to the two systems. RESULTS: The proposed system yielded more balanced patient stratification than the existing system. Progression in the tumor grade according to the proposed system was associated with a poorer prognosis. The 5-year overall and disease-specific survival rates for the entire cohort were 74.9% and 81.8%, respectively. Independent factors affecting overall survival were tumor stage according to the proposed system, excision margins, and number of positive nodes, whereas those affecting disease-specific survival were excision margins and number of positive nodes. CONCLUSIONS: Subsite-specific tumor classification should be used for patients with oral cancer, and our results suggest that mandibular canal tumor classification may be effective for patients with lower gingival carcinoma.

Congenital Epulis: A Rare Head And Neck Tumor in the Newborn.

Congenital epulis is a rare tumor; when voluminous and ulcerated, appearance can generate concern. Nevertheless, it is a benign lesion that is easily treated with surgery. This is a retrospective study, with the presentation of 2 cases treated by the same team from 2016 to 2020 and a bibliographic review (PubMed and Elsiever). This surgical team is based in Buenos Aires, working in the private medical system. Congenital epulis is an infrequent, benign tumor affecting females predominantly, appearing at birth on the alveolar median ridge of the maxilla. Its pathogenesis is uncertain. Voluminous tumors interfere with feeding, but respiratory interference is exceptional. Histologically, this tumor is similar to the granular cell tumor but has different clinical characteristics and Periodic Acid Schiff stain. Prenatal diagnosis with ecographic or magnetic resonance imaging is ideal; if undiagnosed prenatally, clinical diagnosis is done based on typical features. Surgical excision is the treatment of choice.

[Two Cases of Advanced Lower Gingival Carcinoma Treated Surgically Using a Novel Patient-Specific Full Custom- Made Mandibular Reconstruction Plate System].

The treatment of advanced lower gingival carcinoma requires postoperative chemoradiotherapy; therefore, simultaneous hard-tissue reconstruction may not be indicated. In these cases, mandibular reconstruction is performed using a temporal reconstruction plate and various skin flaps. Herein, we reported 2 cases of advanced lower gingival carcinoma treated with a novel computer-assisted patient-specific, fully custom-made mandibular reconstruction plate system(Cosmofix®)in combination with a pedicle/free flap. In case 1, an 80-year-old female patient was diagnosed with right lower gingival carcinoma( cT4aN3bM0, Stage ⅣB). Under general anesthesia, she underwent tracheostomy, bilateral neck dissection, segmental mandibulectomy, and mandibular reconstruction using Cosmofix® in combination with an ulnar forearm free flap. In case 2, an 81-year-old male patient was diagnosed with right lower gingival carcinoma(cT4aN2bM0, Stage ⅣA). The patient underwent maintenance dialysis and required minimally invasive surgery using a pedicle flap. Under general anesthesia, the patient underwent tracheostomy, right modified radical neck dissection, segmental mandibulectomy, and mandibular reconstruction using Cosmofix® in combination with a pectoralis major myocutaneous flap. Postoperative facial morphology, occlusion, eating, swallowing, articulation, and other dysfunctions were minimal in both the cases. Adjuvant chemoradiotherapy was recommended. In conclusion, the utilization of the Cosmofix® system enabled both esthetic and functional reconstruction following segmental mandibulectomy for advanced lower gingival carcinoma.

Large Congenital Epulis: A Neonatal Tumour with Striking Appearance, but Simple Management.

Background Congenital epulis is a benign tumor of upper gingiva. Larger lesions interfere with mouth closing and normal feeding and may obstruct airways. We present a neonate with a large epulis. Case Report: A full term 3 kg 5 days female baby had a 20 cm × 15 cm gingival mass protruding from the oral cavity, connected by a pedicle attached to right upper gingiva (Figure 1). Multiple trophic ulcers had developed in the mass after birth. Mouth closing and normal feeding were hampered. The mass was excised surgically and baby improved. Conclusion: A large congenital epulis, though worrisome to parents, can be satisfactorily managed by surgical excision and has a good prognosis.

[A Case of Lower Gingival Carcinoma Treated Surgically Using Computer-Assisted Patient-Specific Cutting Guide and Mandibular Reconstruction Plate].

We report a case of advanced lower gingival carcinoma treated with a computer-assisted custom-made surgical guide and reconstruction plate system(TruMatch®)in combination with a pectoralis major myocutaneous flap. In a 74-year-old male patient, a neoplastic lesion with a 30×30 mm periapical induration was observed around an extraction socket of left mandibular third molar. After various examinations, we diagnosed lower gingival carcinoma(cT4aN2bM0, Stage ⅣA). The patient was a paraplegic with a spinal cord injury, and reconstruction of mandible with free flap was not indicated, requiring minimally invasive surgery. Therefore, a surgical guide and reconstruction plate were prepared preoperatively using the Tru- Match® system. Under general anesthesia, the patient underwent tracheostomy, left modified radical neck dissection, segmental mandibulectomy, and reconstruction of the mandible using this system in combination with a pectoralis major myocutaneous flap. Postoperatively, the patient had minimal dysfunction. Currently, at 18 months follow up postoperatively, good prognosis was observed. In conclusion, this is a useful surgical system with accurate and less invasive surgery for segmental mandibulectomy of advanced lower gingival carcinoma.

[Surgical Treatment of Maxillary Gingival Carcinoma with Mental Retardation-A Case Report].

Many patients with mental retardation have a limited awareness of abnormalities in the oral cavity, making early detection of oral cancer difficult. Moreover, during examination and treatment, these patients may not understand well-intentioned verbal explanations and may express their anxiety through nonverbal communication. Herein we discuss a case in which favorable results were obtained when surgical treatment was performed on a maxillary gingival carcinoma patient with mental retardation. The patient was a 61-year-old man who was admitted to our hospital with maxillary gingival pain. A biopsy revealed well-differentiated oral squamous cell carcinoma(cT4aN0M0, Stage ⅣA). Hemi-maxillectomy was performed and postoperative recovery was uneventful. A maxillary prosthesis was provided for oral rehabilitation. At the 5-year follow-up, there were no signs of recurrence or metastasis. This case illustrates the importance of collaboration between oral maxillofacial surgeons and specialists from related departments for the comprehensive management of patients with mental retardation.

[A Case of Cavernous Sinus Metastasis following of the Postoperative Maxillary Gingival Carcinoma].

We report a case of cavernous sinus metastasis following postoperative maxillary gingival squamous cell carcinoma. An 83-year-old man was referred to our hospital due to pain in the left maxillary gingiva. Contrast-enhanced computed tomography imaging showed a mass lesion with bone destruction in the left maxillary gingiva. Biopsy indicated the presence of squamous cell carcinoma(T4bN1M0, Stage ⅣB), and the tumor was resected under general anesthesia. Four months after surgery, the patient experienced headache, and orbital pain, failing vision, and movement disorder of the left eye appeared. Magnetic resonance imaging revealed a tumor invading the cavernous sinus and orbit. The lesion was clinically diagnosed as metastatic cavernous sinus following postoperative left maxillary gingival carcinoma. Although the patient underwent chemotherapy, he died from multiple organ failure about 5 months after surgery.

Congenital epulis of the newborn: a case report.

The objective of this case report is to describe a congenital epulis of the newborn. A 10-day-old female neonate was brought to a dental clinic for examination of an intraoral lesion that was present at birth. No systemic changes were noted during the extraoral examination. During the intraoral examination, a nodular exophytic lesion was found in the maxillary left alveolar ridge. The appearance suggested a congenital epulis. The nodular, pedunculated lesion had a diameter of 13 mm, firm consistency, smooth surface, and color varying from pink to red. Newborns with such lesions usually have difficulty breastfeeding and may experience respiratory difficulties. The patient underwent an excisional biopsy under local infiltrative anesthesia with 2% lidocaine. Histopathologic examination of the lesion confirmed the diagnosis of congenital epulis. There were no postoperative complications. At the follow-up examination 8 days after the biopsy, her weight and length had already increased, and the oral mucosa had a normal appearance. At 8 months of age, she demonstrated continued gains in weight and length. Dentists must familiarize themselves with abnormalities that may affect the oral cavity of neonates as well as the differential diagnoses and treatment options.

Congenital granular cell epulis of newborn: importance of prenatal diagnosis.

Congenital granular cell epulis is a rare benign lesion usually arising as single mass from the alveolar ridge of maxillary bone of female newborns, composed of polygonal granular cells that typically stain negative for S-100, in contrast to the adult counterpart. Larger lesions can disturb breathing and breast-feeding, requiring surgery. Prenatal diagnosis is achieved in few cases, even if this would be important for best management of delivery and therapy. Here we present a case of multiple CGCE in a female newborn discovered at birth, together with a brief review of pathogenesis, differential diagnoses and treatment implications of early diagnosis.

Risk Factors for Mandibular Fracture After Marginal Mandibular Resection.

PURPOSE: This study aimed to examine the relationship between post-operative mandibular fractures and its predictable risk factors in patients with marginal mandibular resection. Additionally, the timing of post-operative mandibular fractures was assessed. PATIENTS AND METHODS: Records of 37 patients with mandibular gingival carcinoma who underwent marginal mandibular resection at the Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, from April 2011 to March 2019 were retrospectively analyzed. The following variables were investigated: age, sex, location of carcinoma, tumor size, mandibular height on the surgical and healthy sides, surgical approach, number of residual teeth, post-operative radiotherapy, chemotherapy, and the presence or absence of diabetes and osteoporosis. Various risk factors for post-operative mandibular fractures were statistically investigated. RESULTS: Post-operative mandibular fracture was observed in 5 (13.5%) of the 37 mandibular marginal resection cases. The average residual mandibular height in patients with post-operative mandibular fracture was 8.5 mm. A significant difference in residual mandibular height (P = 0.013) was observed between patients with post-operative mandibular fracture and those with no fracture. The average time to post-operative fracture of the mandible was 305.4 days, and it was found to be correlated to the remaining height of the mandibular body. CONCLUSIONS: A decrease in mandibular height below 9 mm results in post-operative mandibular fracture. Furthermore, a correlation between the height of the mandibular bone and the period until the post-operative mandibular fracture was noted in this study. These findings contribute to the prediction and management of mandibular fractures after mandibular margin resection.

Definitive radiotherapy vs. postoperative radiotherapy for lower gingival carcinomas of the mandible : A single-center report about outcome and toxicity.

PURPOSE: To assess radiotherapy (RT) outcomes in patients with gingival carcinoma and growth up to or involvement of the lower jaw bone. METHODS: This was a retrospective analysis of 51 patients with squamous cell carcinomas of the gingiva. Patients received definitive (group 1, 31.4%) or postoperative (group 2, 66.7%) RT between 2005 and 2017 at the Department of Radiation Oncology, University Hospital Heidelberg. The primary endpoint was overall survival (OS) in both treatment groups. Other endpoints were local-disease-free survival (LDFS), progression-free survival (PFS) and treatment-related toxicity (Common Terminology Criteria for Adverse Events, CTCAE, Version 4.03). RESULTS: Median age at first diagnosis was 63 years. All patients had a local advanced disease (American Joint Commission on Cancer [AJCC] stage III-IV). After a median follow-up of 22 months (range 3-145 months), 20 patients (39.2%) were still alive. At 5 years, OS rate was 36.6%. No significant differences in OS (p = 0.773), PFS (p = 0.350) and LDFS (p = 0.399) were observed between the two groups. Most common higher-grade acute RT-related complications (≥ grade 3) were dermatitis (78.2%), oral mucositis (61.7%), xerostomia (51.5%), and loss of taste (74.6%). Three cases (5.8%) of osteoradionecrosis (ORN) of the lower jaw were detected after 15-31 months. CONCLUSIONS: Definitive and postoperative RT have similar treatment outcomes for patients with lower gingiva carcinomas of the lower jaw. The most common acute complications (grade ≥3) were dermatitis, oral mucositis, xerostomia and loss of taste.

Oncologic outcome of marginal mandibulectomy in squamous cell carcinoma of the lower gingiva.

BACKGROUND: There is a large amount of controversy about the best management of the mandible in oral squamous cell carcinoma (SCC), mainly owing to the inability to acquire accurate bone invasion status. Therefore, our goal was to analyse the oncologic safety in patients undergoing marginal mandibulectomy (MM) for cT1-2 N0 SCC of the lower gingiva. METHODS: Patients undergoing MM for untreated cT1-2 N0 SCC of the lower gingiva were retrospectively enrolled. The main endpoints of interest were locoregional control (LRC) and disease-specific survival (DSS). RESULTS: A total of 142 patients were included in the analysis, and a pathologic positive node was noted in 27 patients. Cortical invasion was reported in 23 patients, and medullary invasion was reported in 9 patients. The 5-year LRC and DSS rates were 85 and 88%, respectively. Patients with bone invasion had a significantly higher risk for recurrence than patients without bone invasion. However, the DSS was similar in patients with versus without bone invasion. Patients with a high neutrophil lymphocyte ratio had a higher risk for worse prognosis. CONCLUSIONS: The oncologic outcome in patients undergoing MM for cT1-2 N0 SCC of the lower gingiva was favourable; bone invasion was not uncommon, but it significantly decreased the prognosis in patients undergoing MM.

Elective neck dissection (END) and cN0 hard palate and upper gingival cancers: A National Cancer Database analysis of factors predictive of END and impact on survival.

BACKGROUND AND OBJECTIVES: The reported risk of nodal metastasis in hard palate and upper gingival squamous cell carcinoma (SCC) has been inconsistent with inadequate consensus regarding the utility of neck dissection in the clinically negative (cN0) neck. MATERIALS AND METHODS: Using the National Cancer Database, cN0 patients diagnosed with SCC of the head and neck with the subsites of the hard palate and upper gingiva were identified from 2004 to 2014. RESULTS: A total of 1830 patients were identified, and END was performed on 422 patients with cN0 tumors. Pathologically positive nodes occurred in 14% (59/422) of patients in this cohort. Higher tumor stage, academic hospital type, and large hospital volume (>28 cancer-specific cases/year) were associated with a higher likelihood of END both in univariate and multivariate analyses (P < .05). Patients >80 years of age were less likely to receive END on multivariate analysis (OR 0.52, 0.32-0.84). No variables, including advanced T stage, predicted occult metastases. Cox proportional hazards regression analysis showed that patients who underwent END demonstrated improved OS over an 11-year period (hazard ratio 0.75, P = .002). On subgroup analysis, this improvement was significant in patients with both stage T1 and T4 tumors. CONCLUSIONS: Tumor stage, hospital type, and hospital volume were associated with higher rates of END for patients with cN0 hard palate SCC and after controlling for clinical factors, END was associated with improved overall survival.

Metastasis of lower gingival squamous cell carcinoma to buccinator lymph node: case report and review of the literature.

BACKGROUND: Metastasis of oral cancer to the buccinator lymph nodes (BN) is uncommon. The antegrade lymphatic flow in patients with normal anatomy and physiology makes metastasis of lower gingival cancer to BN unlikely. CASE PRESENTATION: A 67-year-old woman presented with a 46 × 25-mm tumor on her lower gingiva, along with metastatic foci in BN and cervical lymph nodes. After neoadjuvant chemotherapy, she underwent radical resection of the primary tumor and BN, along with neck dissection. Following surgery, she received adjuvant chemoradiotherapy. Two years after treatment, there has been no evidence of tumor recurrence or metastasis. CONCLUSION: This is the first report of lower gingival squamous cell carcinoma with metastasis to BN. Metastasis to BN from lower gingival cancer is very rare but should be considered in patients with locally advanced tumors or tumors that metastasize to the submandibular node.

Nerve sheath myxoma of the oral cavity: a distinct entity.

Nerve sheath myxomas (NSM) are uncommon benign tumours of nerve sheath origin. These tumours are most often located in the dermis and subcutaneous tissue of the head and neck region, but less frequently can also involve extracutaneous sites but they are rarely seen in the oral cavity. Many authors consider nerve sheath myxoma and neurothekeoma to be variants of the same tumour, though currently it has been demonstrated that both the lesions are distinct entities with different origins and unique morphological features. Herein we report a case of Nerve Sheath Myxoma on the palatal gingiva.

What Is a Safe Distance for Preservation of the Inferior Alveolar Nerve in Lower Gingival Squamous Cell Carcinoma? A Radiographic and Histopathological Study.

PURPOSE: Involvement of the inferior alveolar nerve (IAN) is important in the prognosis and treatment of gingival squamous cell carcinoma (SCC). METHODS: In this cross sectional study, patients with gingival SCC (T4a), undergoing hemimandibulectomy or subtotal hemimandibulectomy, were examined. The distance between the lesion and inferior alveolar canal (IAC) was measured, using axial computed tomography scans before resection. Following that, histopathological evaluation of IAN was conducted. The receiver operating characteristic curve was plotted to determine the association of IAN involvement in histopathological evaluation with various distances between the lesion and IAC. RESULTS: A total of 29 patients were examined in this study. The mean distance between the lesion and IAC was 9.40 ±â€Š2.21 mm. Nerve involvement was documented in 9 (45%) out of 20 males, while 11 (55%) men showed no involvement. Thirteen (44.82%) patients showed IAN involvement. The receiver operating characteristic curve demonstrated a cut-off point of 9.75 mm for the lesion-IAN distance. The possibility of IAN involvement was 23.33 times higher in patients who reported paresthesia, compared with patients without nerve involvement (odds ratio, 23.33; 95% CL; P = 0.001) CONCLUSION:: It seems that in a CT scan view, a 9.75-mm safe margin is associated with high accuracy for preserving IAN in patients with gingival SCC. Also, neurosensory disturbance can be considered a strong predictor of IAN involvement.

[Carcinoma cuniculatum: An unusual oral tumor]. / Carcinome cuniculatum : une tumeur orale inhabituelle.

We report on a case of carcinoma cuniculatum (CC) of the maxillary gingival mucosa. A 60-year-old woman presented with an exophytic gingivo-palatal mass with slow growth and osteolytic evolution. A first performed biopsy was negative for malignancy. The diagnosis of CC was established on the surgical representative biopsy. CC is a rare low-grade variant of squamous cell carcinoma that is usually found in the foot or in oral cavity. The pathognomonic microscopic feature of CC is an endo- and/or exophytic lesion composed by a well differentiated squamous epithelium infiltrating into underlying stroma forming a complex pattern of keratin cores and keratin filled "rabbit warren" crypts. CC is a locally evolutive carcinoma with a usually good prognosis usually without lymph node or distant metastatic evolution.

Oral peripheral ameloblastoma: A retrospective series study of 25 cases.

BACKGROUND: Peripheral ameloblastoma (PA) is a rare and unusual variant of odontogenic tumor, which was described only in isolated case reports in literature. The objective of this study was to investigate the clinical profile, treatment and outcome of PA in a consecutive case series. MATERIAL AND METHODS: A total of 25 patients with histologically confirmed PA from 2001 to 2015 were retrospectively reviewed in our institution. RESULTS: Of the 25 patients, 22 males and 3 females were identified (male: female = 7.3:1). The average age was 48.3 years (range 11-81 years) with lingual or palate gingival region being the most common site (76%). The course of disease was less than 6 months in 92.0% (23/25) of all patients (mean, 3.3 months; range, 1-12 months). All patients underwent complete surgical removal of the lesions, and one lesion recurrence occurred during the follow-up period. CONCLUSIONS: The clinical profile and outcome of PA from Eastern China were elucidated in this retrospective analysis based on a case series. Our experience may provide some insights into the differential diagnosis and clinical management of PA. The first choice of treatment is surgical excision, which can result in a good prognosis.

Congenital Epulis: A Case and Review of the Literature.

Congenital epulis is an unusual benign oral mucosal lesion in newborns with no tendency to recur after excision. The histogenesis of the lesion is unknown, but it is believed to be of mesenchymal origin. We describe a case of congenital epulis (20×10 mm) in the mandibular gingiva of a newborn. The mass, which was smooth-surfaced and pedunculated with a healthy color, was surgically removed at 5 months post-birth. Histologically, the tumor consisted mainly of large eosinophilic granular cells. Immunohistochemical studies revealed intense staining for vimentin, STRO-1, and CD44, suggesting that it was derived from mesenchymal cells. The literature and immunohistochemical profile of congenital epulis are also discussed.

[Concurrent nodal and extranodal lymphoma misdiagnosed as metastatic gingival carcinoma: A case report].

Early diagnosis of malignant lymphoma is often difficult since the clinical manifestation of the lymphoma occurred in the maxillofacial region is very similar to that of the squamous cell carcinoma. When the pathological diagnosis is not clear, the surgeon is easy to misdiagnose and lead to mistreatment. A patient visited the Affiliated Haikou Hospital of Xiangya School of Medicine, Central South Universily for gingival mass with an ipsilateral submaxillary enlargement. The clinical manifestation and preoperative MRI are very prone to squamous cell carcinoma with metastasis, so we did not take a preoperative pathological examination. The gingival mass was surgical removed firstly, but frozen pathological result showed that it was malignant small round cell tumor. Since the patient was diagnosed as high degree malignant of small round cell tumor and the submandibular region have been significantly metastasized, so we carried out the combined radical dissection of gingival, mandible and neck surgery. The postoperative pathological report was malignant lymphoma, suggesting that the patient was a case of misdiagnosis and mistreatment. This article draws lessons from misdiagnosis and provided experience for seeking improvement measures.