Staging of squamous cell carcinoma of the tongue: extrinsic lingual muscles and the 8th editions of the American Joint Committee on Cancer/Union for International Cancer Control staging manuals.

Our aim was to find out first whether the extrinsic muscles of the tongue are histologically identifiable, and secondly to what degree the use of the new criteria in the 8th editions of the American Joint Committee on Cancer(AJCC)/Union for International Cancer Control (UICC) manuals (which have recognised the importance of depth of invasion of tumour, rather than invasion of the extrinsic muscles of the tongue and extranodal extension), will alter staging of lingual squamous cell carcinoma (SCC). The histological sections from 165 patients who had had primary resection of lingual SCC were reviewed, and one or more extrinsic muscles of the tongue was identified in 100 patients (61%), with the genioglossus seen the most often (in 96). By contrast, the hyoglossus was identified in only eight patients, the styloglossus in two, and the palatoglossus in none. Identification was straightforward only in extensive resections. Applying the criteria from the 8th edition increased the number of pT3 SCC with a simultaneous reduction in pT4a tumours. The number of pN2b SCC was also reduced, but the new category of pN3b meant that overall 53% of tumours were upstaged. The kappa scores for agreement between the two sets of criteria were 0.221 (weighted 0.410) for the pT values, 0.508 (0.713) for pN values (but 0.227, weighted 0.386, if the pN0 values were removed before calculation), and 0.243 (0.514) for overall stage, indicating poor to fair agreement. We conclude that the removal of invasion of extrinsic muscles of the tongue as a criterion for a pT4a SCC is justified, and that many SCC of the tongue will be upstaged as a result of implementation of the 8th editions.

Fractalkine (CX3CL1) and fractalkine receptor (CX3CR1) in squamous cell carcinoma of the tongue: markers of nerve invasion?

PURPOSE: Perineural invasion (PNI) in oral squamous cell carcinoma (SCC) is an independent predictor of poor prognosis. As PNI is not always identified with routine histology, a surrogate marker of PNI would improve detection and better inform treatment planning. The chemokines fractalkine (CX3CL1) and its receptor (CX3CR1) have shown such potential in other cancers, but have yet to be investigated with respect to PNI in oral SCC. METHODS: Thirty SCCs of the tongue in which PNI was identified histologically, and 30 in which it was not, were stained for fractalkine and fractalkine receptor using polyclonal antibodies and an immunoperoxidase technique. Tumours were assessed as either positive or negative; no attempt was made to subjectively assess staining intensity or extent. RESULTS: Both markers labelled myofibroblasts in the stroma surrounding the tumour, various neural components, leucocytes, endothelium and salivary myoepithelial cells. Fractalkine also labelled salivary ductal epithelium, vascular smooth muscle and 12/30 SCC which showed PNI. Eight of 30 positive SCCs in which PNI was not identified were also positive for this marker. There was no statistically significant association between fractalkine staining and PNI (p = 0.273). No SCC was positive for fractalkine receptor, but immune dendritic cells within tumour islands were strongly positive, as was striated muscle. CONCLUSIONS: Neither fractalkine nor fractalkine receptor is a reliable surrogate marker of PNI in lingual SCC.

Hemimandibulectomy and vascularized fibula flap in bisphosphonate-induced mandibular osteonecrosis with polycythaemia rubra vera.

This report presents the successful management of an advanced and refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) by hemimandibulectomy and an osteocutaneous fibula flap reconstruction in a patient with polycythaemia rubra vera, a rare haematological condition in which there is increased risk of thrombosis and haemorrhage. Union of the vascularized bone with the mandible depends on obtaining a BRONJ-free margin and rigid fixation of the bony ends. Magnetic resonance imaging can provide accurate delineation of necrotic bone and area of osteomyelitis. Placement of a 1cm margin beyond this can envisage a BRONJ-free margin. Aggressive medical management of polycythaemia rubra vera by venesection, asprin and cytoreduction therapy along with anticoagulant prophylaxis against thromboembolic events in the first 2 weeks following major surgery can provide the basis of a good surgical and flap outcome. Nevertheless, the possibility of unpredictable haemorrhage must be considered throughout.

Bilateral intraparotid and extraparotid Warthin's tumours.

Warthin's tumour is a benign adenoma in the parotid gland, but extraparotid and synchronous bilateral Warthin's tumours may occur. In this report, we describe a patient with simultaneous bilateral involvement of the parotid glands and neck by multiple Warthin's tumours, an occurrence not previously described.

Sensory and motor function impairment after brachial plexuscord compression by a pedicled latissimus dorsi flap.

A case of neuropraxia of the sensory and motor nerve fibres of the brachial plexus is reported after successful transfer of an ipsilateral pedicled myocutaneous latissimus dorsi flap to reconstruct a large-volume tissue defect in the neck resulting from a shotgun injury.

A minor salivary gland tumour presenting with dysphagia.

A case is reviewed of a giant benign myoepithelioma of the soft palate presenting in an elderly female patient. Due to the large size of the lesion and its mass effect the patient developed dysphagia with subsequent significant weight loss. The clinico-pathological features of this rare tumour are described and the literature reviewed.

Relation of preoperative sialographic findings with histopathological diagnosis in cases of obstructive sialadenitis of the parotid and submandibular glands: retrospective study.

The clinical records, preoperative sialograms and histopathological slides of 33 patients who had been operated on for symptoms of obstructive salivary gland disease were reviewed. Twenty patients had had superficial parotidectomy and 13 excision of the submandibular gland. Among those who had required parotidectomy, preoperative sialograms tended to suggest more architectural damage than was actually noted on definitive histopathological examination. Patients whose symptoms had been present for longer had more severe sialographic and histopathological changes. In the submandibular group, there was a closer relation between sialographic and histopathological changes, and a positive correlation between a short history and the severity of histopathological grading. These differences may reflect the different aetiology and course of obstructive disease in the two types of gland.

Restricted mandibular opening complicating intraoral galeal flap reconstruction and radiotherapy: case report.

Despite many advantages over musculocutaneous and free flaps, galeal flaps are seldom used intraorally by the head and neck surgeon. The literature reveals little in the way of complications of such flaps. A case is reported in which a temporoparietal galeal flap used in reconstruction after resection of an intraoral squamous cell carcinoma, followed by a course of radiotherapy, led to postoperative restriction of mandibular opening. The combination of surgery and radiotherapy with the intraoral use of this flap may lead to flap fibrosis and limited mouth opening.