Submandibular gland invasion and feasibility of gland-sparing neck dissection in oral cavity carcinoma.

OBJECTIVE: This study investigated the incidence and routes of submandibular gland involvement in oral cavity carcinoma to determine the feasibility of submandibular gland sparing neck dissection. METHODS: The records of 155 patients diagnosed with oral cavity squamous cell carcinoma, with a total of 183 neck specimens, including those involving level I, were reviewed retrospectively. RESULTS: Submandibular gland involvement, via direct invasion from the anatomical proximity of T4a tumours, was evident in two patients. The floor of mouth location, either primarily or as an extension of the primary tumour, was the only risk factor for submandibular gland involvement in oral cavity carcinoma (p = 0.042). Tumour location, clinical and pathological tumour (T) and nodal (N) stages, and radiological suspicion of mandible invasion, were not found to be statistically relevant (p > 0.05). CONCLUSION: The results suggest the feasibility of preserving the submandibular gland in early stage oral cavity carcinoma unless the tumour is located in, or extends to, the floor of mouth.

Patterns of cervical lymph node metastases in oral tongue squamous cell carcinoma: implications for elective and therapeutic neck dissection.

OBJECTIVES: To determine the patterns of lymph node metastases in oral tongue carcinomas, and examine the implications for elective and therapeutic neck dissection. METHOD: The study entailed a retrospective analysis of 67 patients with previously untreated oral tongue squamous cell carcinoma who had undergone simultaneous glossectomy and neck dissection. RESULTS: Of the 40 clinically node-negative patients, 7 patients had metastatic lymph nodes on pathological examination. No occult metastasis was found at level IV. Of the 27 clinically node-positive patients, the incidence rate of level IV metastasis was 11.1 per cent (3 out of 27 patients). No 'skip metastases' were found at level IV. Level IV metastases were significantly related to clinically staged nodes categorised as over 2a (p = 0.03) and metastasis to level III (p = 0.01). CONCLUSION: Routine inclusion of level IV in elective neck dissection is not necessary for clinically node-negative patients with oral tongue squamous cell carcinoma. Furthermore, extended supraomohyoid neck dissection with adjuvant radiotherapy can be sufficient in the treatment of selected patients with clinically node-positive necks.

Accelerated radiotherapy in locally advanced head-neck carcinomas: are concomitant boost and chemotherapy feasible in the routine outpatient-based radiotherapy clinic?

PURPOSE: Accelerated radiotherapy and concurrent chemoradiotherapy is an effective treatment modality in locally advanced head and neck carcinomas. In this study, we examined the efficacy and feasibility of concomitant boost radiotherapy and chemotherapy in the routine outpatient- based radiotherapy clinic. PATIENTS AND METHODS: Between January 1993 and December 2000, only 51 out of 127 eligible patients were deemed suitable to receive concomitant boost radiotherapy and/or chemotherapy. Their median age was 60 years (range 17-83 years). The histological diagnosis was squamous-cell carcinoma in 38 (75%) patients, undifferentiated nasopharyngeal carcinomas (WHO type III) in 10 (20%) patients and other histology in 3 (5%) patients. The concomitant boost regimen consisted of 70 Gy in 6 weeks (1.8 Gy/fraction/day, 5 days/week, to the clinical target volume (CTV), and 1.6 Gy/fraction/day to the gross tumor volume (GTV) as a second-daily treatment for the last 2 weeks). The concomitant chemotherapy regimen consisted of cisplatin 100 mg/m(2) given every 3 weeks for 3 courses, and the neoadjuvant regimen of cisplatin 100 mg/m(2) plus epirubicin 100mg/m(2), every 3 weeks for 3 courses. RESULTS: Only 55% of patients completed the treatment exactly as planned, with 82% completing treatment within acceptable limits. The median radiotherapy duration was 45 days (40-95 days). In univariate analysis, patients with better performance status (p=0.002) or nasopharyngeal carcinomas (p=0.043) had a significantly better compliance to treatment. In multivariate analysis only nasopharyngeal site was a significant predictor of compliance (p=0.019). The maximum acute reaction was grade 3 mucositis in 24 (49%) patients. No grade 4 acute or late reactions were seen. Complete and overall response rates were 51% and 75.5%, respectively. Patients with nasopharyngeal cancer and good treatment compliance had a better response rate (p=0.009 and 0.01, respectively). The median follow-up period of surviving patients was 28 months (range 6-58 months). The 3-year progression-free survival rate was 39%. CONCLUSION: In the routine outpatient-based setting we found that this intensive treatment schedule can only be given to a limited and highly selected group of patients.

Pharyngocutaneous fistula and total laryngectomy: possible predisposing factors, with emphasis on pharyngeal myotomy.

Ninety-two total laryngectomy cases were investigated with reference to post-laryngectomy fistula formation. Fistula was observed in eight cases (8.69 per cent). There were no statistically significant differences between the fistula group and the non-fistula group with regard to pre-operative tracheotomy, tumour differentiation, positive surgical margins, concurrent neck dissection, previous radiotherapy, T stage of the tumour, presence of extended hypopharyngeal mucosal excision, and placement of nasogastric tube. The only statistically significant positive association was found with primary pharyngeal myotomy. Myotomy was performed in six of the fistula patients and in two cases a technical error was observed. In these cases myotomy was performed adjacent to the edge of hypopharyngeal mucosa resulting in a weakened area of pharyngeal closure, possibly contributing to the fistula. This should be kept in mind and avoided at all costs during the performance of myotomy. Since it was not possible to find out any specific causal relationship with myotomy in four other cases, further studies are needed to establish the association of myotomy with pharyngocutaneous fistula.

Metastatic thyroid carcinoma of the mandibule.

A case of metastatic papillary carcinoma to the mandible is presented. Though relatively rare, metastatic tumours of the mandible should be included in the differential diagnosis of the tumours in the parotid region. For the primary site; being in the cervicofacial region, the thyroid gland must be considered by the head and neck surgeon.