Correction to: Elective Neck Dissection Versus Observation in cT1-T2 Oral Tongue Squamous Cell Carcinoma: A Meta-Analysis of 11,973 Patients.

[This corrects the article DOI: 10.1007/s12070-020-02118-y.].

Elective Neck Dissection Versus Observation in cT1-T2 Oral Tongue Squamous Cell Carcinoma: A Meta-Analysis of 11,973 Patients.

The surgical management of the clinical negative neck node in early oral tongue squamous cell carcinoma (OTSCC) has been the topic of debate since few decades. As the occult cervical lymph node metastasis is considered to be the prime prognostic factor in early OTSCC, this meta-analysis has been carried out to find the risk of regional nodal recurrence, disease specific survival and overall survival rates in outcome of Elective neck dissection (END) versus patients under observation. The articles were electronically retrieved from Ovid Medline, PubMed, Cochrane and Scholar for comparison of END versus Observation in early OTSCC. The search strategy identified 37 relevant review articles from April 1979 to April 2020 from different search engines. A total of 11,973 patients from 32 retrospective analysis, 4 prospective and 1 randomised control trial were included in this meta-analysis. Statistical analysis revealed Overall test (OR: 5.31 95% CI: - 2.132-14.698) with t-test 1.919 and p value 0.113 which is not statistically significant but the readings says that there is always better Disease specific survival with END patients rather than patients kept on observation. Overall test revealed (OR: 13.02 95% CI: 1.360-17.154) with t test 2.382 and p value 0.023 which is statistically significant and showed that End significantly reduced the risk of regional nodal recurrence. Overall test revealed (OR: 7.93 95% CI: - 15.461-4.238) with t test - 1.347 and p value 0.220 which is statistically insignificant and but showed that to some extent Overall survival improves in patient with END than the patients kept on observation. This meta-analysis find that there is statistically significant relationship when Elective neck dissection was performed which reduced the risk of regional nodal recurrence. This analysis didn't statistically find any significance in Disease specific survival and Overall survival with Elective neck dissection patients rather than patients kept on observation but however showed good prognosis when elective neck dissection was performed.

Genomic and transcriptomic alterations in m6A regulatory genes are associated with tumorigenesis and poor prognosis in head and neck squamous cell carcinoma.

Genetic alterations in N6-methyladenosine (m6A) regulatory genes are observed in many cancers. Recent studies have shown that newly identified m6A regulatory gene family (IGF2BPs; IGF2BP1, IGF2BP2, and IGF2BP3) were highly expressed in various types of cancer that stabilize and promote translation of multiple oncogenes, resulting in tumor development, survival and drug resistance. However, the oncogenic roles and prognostic values of IGF2BPs in head and neck squamous cell carcinoma (HNSCC) remain largely unknown. In this study, we examined the m6A regulatory genes alteration, their mRNAs expression and the prognostic values in HNSCC. We also analyzed the interaction network and functional enrichment of m6A regulators. Our results showed that m6A regulatory genes were altered in 41% (205/504) of HNSCC patients, of which IGF2BP2 was amplified in 20% (101/504) of HNSCC patents and positively correlated with its mRNA expression. Importantly, we have validated the expression of IGF2BP2 in HNSCC and normal tissue samples. Interestingly, we also found that the IGF2BP2 was frequently co-amplified with the most common oncogenes in HNSCC patients. In addition, this study found that other m6A regulatory genes such as METTL3, METTL14, WTAP, KIAA1429, ZC3H13, RBM15, ALKBH5, FTO, YTHDF1, YTHDF2, YTHDF3, YTHDC1, IGF2BP1, and IGF2BP3 were significantly upregulated in HNSCC samples. Moreover, patients with high expression of IGF2BP1, IGF2BP2, and IGF2BP3 had poor overall survival (OS) than those with low expression. Therefore, it is evident that IGF2BP family plays a key role in the oncogenesis of HNSCC and might serve as novel prognostic biomarkers and potential therapeutic targets in HNSCC.

Aberrations of m6A regulators are associated with tumorigenesis and metastasis in head and neck squamous cell carcinoma.

OBJECTIVE: N6-Methyladenosine (m6A) is the most common RNA modification in eukaryotic mRNAs and growing evidence suggests that m6A modification and its regulators play crucial roles in human cancers. However, the role of m6A regulators and their molecular mechanisms in head and neck squamous cell carcinoma (HNSCC) remains largely unclear. METHODS: We therefore assessed m6A regulatory genes alterations and their mRNAs expression in HNSCC using openly available data from The Cancer Genome Atlas (TCGA). Further, we have validated the expression level of m6A regulatory gene in HNSCC tissue samples using real-time PCR. In addition, we also analyzed the protein interaction network, and functional enrichment of m6A regulatory genes. RESULTS: Analysis of TCGA data revealed that m6A regulatory genes were altered in many HNSCC patients. Importantly, we found for the first time that m6A "writer" KIAA1429 (VIRMA) was frequently amplified and mutated (8 %), which contributes to the overexpression of KIAA1429 mRNA, and the overexpression of KIAA1429 could be remarkably related to cancer stages, tumor grade, and nodal metastasis (P < 0.05). In addition, the overexpression of KIAA1429 was successfully validated using HNSCC tissue samples. CONCLUSIONS: Our findings suggest that the genetic alterations of m6A regulatory genes are associated with tumorigenesis and metastasis in HNSCC, which may provide clues to identify new therapeutic targets for HNSCC.

Modified Bilateral Perialar Crescent Flap for Reconstruction of Combined Upper Lip and Premaxillary Defect.

Many reconstruction methods are performed for combined defects of upper lip and premaxilla in oral cancer patients, which are complicated and multiple staged procedures, compromising the functional or structural unit. In this case report, we present a modification of the bilateral perialar crescent flap for reconstructing the combined defect of upper lip and premaxilla in a single stage. A patient diagnosed with well-differentiated squamous cell carcinoma of premaxilla and upper lip, involving a surgical defect of more than one-third but less than two-thirds of the lip underwent two cycles of neoadjuvant chemotherapy. Later wide local excision of the lesion and simultaneous reconstruction with a modified perialar crescent flap was performed in a single stage. Patient recovered uneventfully and tolerated the procedure well, without any complications. The patient was found to be satisfied with the functional and esthetic result. The reduced upper lip support which was a result of the bony defect of the premaxilla, was corrected with a dental prosthesis. This modification is a useful reconstruction tool for oral cancer patients with combined defects of upper lip and premaxilla.

Metastatic Tumour to the Mandible - A Diagnostic and Management Dilemma.

Metastatic tumours of the jaw are overlooked due to their relatively rare incidence. However, they are often the first indicators of an unknown primary malignant lesion. In this case report, we present a 68-year-old male patient with a suspected intraosseous malignancy of the mandible who was treated by a right segmental mandibulectomy. The final histopathology report was indicative of a secondary metastatic tumour. Positron emission tomography scan revealed a suspicious lesion in the right lung, which was identified as the primary tumour by biopsy using the Tru-Cut® biopsy device (MeritMedical, Jordan UT). The metastatic lesion to the oral soft tissues was easily recognized, in contrast to the jawbone metastasis. Differentiating between primary intraosseous and metastatic mandibular tumours relies on the histopathologist and the surgeon working in tandem to arrive at an early conclusive diagnosis. Knowledge of metastatic tumours to the facial bones is indispensable to a surgeon as it can often be the first indication of an unknown primary malignancy. Identification of early signs, appropriate and timely investigative procedures, coordination between pathologist and surgeon, and choosing the correct treatment modality can help prolong and improve the quality of life of the patient.

Primary peripheral primitive neuroectodermal tumor of the mandible.

Primitive neuroectodermal tumor (PNET) is a broad term that includes a wide array of lesions with varying differentiating potential affecting both the central and peripheral nervous system. Peripheral PNET (pPNET), a variant of PNET, is known to arise in many places throughout the body; involvement of the mandible is however rare. A review of the scientific literature describes only seven reports of pPNET to be arising from the mandible. Given their insidious clinical symptoms, variable locations and rarity, the accurate diagnosis of peripheral PNETs poses a challenge for clinicians. PNETs exhibits characteristic immunophenotypical and genetic features that distinguish them from other small round cell tumors. A multidisciplinary approach is necessary to manage patients affected by PNET. There is however no consensus about the best therapeutic strategy. We recently got to treat a young patient with mandibular PNET; the clinical course as well as the histopathology with immunohistochemistry correlation of this rare entity is discussed.

Microsurgical free flaps: Controversies in maxillofacial reconstruction.

Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps.