Tracing human papillomavirus in skin and mucosal squamous cell carcinoma: a histopathological retrospective survey.

Worldwide, squamous cell carcinoma (SCC) incidence is rising. The literature debates the human papillomavirus (HPV)'s role in cutaneous SCC development. We examined HPV histopathology in SCC samples in this study. Retrospective study at tertiary referral skin center in 2020. Histopathological features of HPV, including koilocytosis, hyperkeratosis, acanthosis, hypergranulosis, parakeratosis, solar elastosis, papillomatosis, and tumor grade, were examined in SCC specimens. Two dermatopathologists independently reevaluated all samples. We examined 331 SCC cases (male:female ratio = 3.9:1). The mean age was 68.1, with 15.1 standard deviation. Lesions were most common on the face (40.5%), scalp (22.7%), and extremities (20.8%). Koilocytes were found in 50 (15.1%) lesions. Nail (38.1%, p=0.007), oral cavity (36.8%, p=0.014), and genitalia (60.0%, p=0.026) lesions had higher koilocytosis rates. SCCs were found in 6.6% of specimens, but in situ tumors had the highest koilocytosis (64.7%), significantly higher than other grades (p<0.001). SCC pathology often shows HPV and specific koilocyte histopathology. Well-differentiated SCC has a stronger association with nail, oral, and genital lesions.

Evaluation of different doses of dexmedetomidine for awake fibreoptic nasotracheal intubation in patients undergoing oromaxillofacial and oral malignancy surgeries: A randomised, double-blind study.

Background and Aims: In patients undergoing cancer surgeries with anticipated difficult airway, awake fibreoptic nasotracheal intubation (AFONI) is critical for securing the airway. However, different doses of dexmedetomidine (DEX) are yet to be evaluated in these patients. Thus, we compared three doses of DEX for AFONI in patients undergoing oromaxillofacial and oral malignancy surgeries. Methods: In this randomised, double-blind study, 90 patients aged 18-60 years of either gender, with American Society of Anesthesiologists physical status I/II, and undergoing elective oromaxillofacial and oral malignancy surgeries were randomised to three groups: Group D1 (0.5 µg/kg DEX), Group D2 (1 µg/kg DEX), and Group D3 (1.5 µg/kg DEX). The primary outcome measure was the airway obstruction score. Secondary outcome measures were intubation scores (including vocal movement, coughing, and limb movements) and a 5-point fibreoptic intubation comfort score. Sedation was assessed using the Ramsay sedation score (RSS). One-way ANOVA and Chi-square test were used to assess the association between quantitative and qualitative variables, respectively. A P value of <0.05 was considered statistically significant. Results: The airway obstruction score was comparable between the groups (P = 0.78). Similarly, vocal movement (P = 0.15), coughing (P = 0.31), limb movement (P = 0.51), and 5-point fibreoptic intubation comfort score (P = 0.49) did not differ between the groups. The mean RSS was significantly greater in Group D3 than in Groups D1 and D2 (P = 0.001). Conclusions: In combination with topical spray and airway block, all three doses of DEX resulted in comparable airway obstruction scores and thus provided favourable conditions for AFONI.

Evaluating Pedicled Pectoralis Major Myocutaneous Flap Reconstructions for Oral Malignancy and the Influence of Laterally Based Rotational Advancement Flap on Donor Site Integrity and Nipple Position in Male Patients.

Oral cancer poses a significant health burden, particularly in the male population of India. This study focuses on evaluating the outcomes of 48 pedicled Pectoralis major myocutaneous (PMMC) flap reconstructions in male patients with oral malignancy. Given the challenges associated with microvascular flap reconstructions, especially in advanced cancer cases, older patients, and resource-constrained settings, the PMMC flap still serves as a valuable alternative. The study introduces a novel approach by incorporating a laterally based rotational advancement flap (LBRA) to address donor site integrity and decrease the nipple-areolar complex (NAC) displacement. Traditionally, PMMC flap designs tend to cause inward shifting of the NAC during chest donor site closure, impacting the aesthetic outcome. Surgical techniques involved wide local resection, neck dissection, and PMMC flap reconstruction. The Flap design included a horizontal orientation with adjustments based on defect location. Additionally, a laterally based rotational flap from the chest aided in donor site closure. Results demonstrate the versatility and reliability of PMMC flap reconstructions, with no total flap necrosis or major complications observed in the 48 cases. The LBRA technique effectively mitigated NAC displacement. The study contributes to the existing literature by providing insights into the advantages of PMMC flap reconstructions and introducing a technique to optimize donor site closure and decrease the medial shifting of the nipple. The adaptability, reliable vascular supply, and simplified learning curve make the PMMC flap a preferred choice in resource-constrained settings with high patient demand. In conclusion, this research underscores the continued relevance and effectiveness of the PMMC flap in head and neck reconstruction, offering satisfactory cosmetic and functional results. The introduction of the LBRA technique adds a nuanced dimension to improve outcomes, particularly in male patients with oral malignancy.

Oral Potentially Malignant Disorders and Oral Cancer in Saudi Arabia: An Epidemiological Review of the Literature.

Background: Oral potentially malignant disorders (OPMDs) are a group of chronic oral mucosal diseases associated with an increased risk of malignant transformation. Multiple studies have investigated the prevalence of these conditions in multiple regions; however, there are limited data about the prevalence of OPMDs in the Kingdom of Saudi Arabia (KSA). This paper aims to review the prevalence of OPMDs in the KSA, to ensure better understanding of the population risk and propose a more standardised approach to the diagnosis and management of this group across the KSA. In addition, this review will discuss the prevalence of oral cancer in the KSA, considering independent risk factors for oral cancer development. Methods: Electronic databases including PubMed, Medline, Medscape, ScienceDirect, StatPearls, BMC Oral Health and the Cochrane Library were searched with the keywords "Oral Potentially Malignant Disorders"; "Saudi Arabia"; and "Oral Cancer". Identified articles were reviewed independently by 2 reviewers against defined inclusion and exclusion criteria. Results: 16 studies were included in this review. The prevalence of OPMDs in KSA varies significantly depending on age, gender, social habits, background disease and dental status. Conclusions: This review highlights the need for up-to-date data on the prevalence, distribution, and characteristics of OPMDs in KSA. The diverse prevalence rates and distinct characteristics of various OPMDs emphasise the necessity for targeted preventive measures. As the data on OPMDs in KSA remains limited, future research efforts should prioritise the establishment of comprehensive epidemiological studies to inform effective public health interventions in this region.

Clinical retrospective analysis of peri-implant oral malignancies.

PURPOSE: Complications of implant prostheses have direct correlation with the increased use of implants for dental rehabilitation. In this study, we present cases of peri-implant oral malignancies (PIOM) around dental implants and a retrospective analysis of patients treated for PIOM. METHODS: The retrospective analysis was performed with patients treated for PIOM at the Department of Oral and Maxillofacial Surgery of the Seoul National University Dental Hospital between 2006 and 2014. The patient records were thoroughly screened for previous medical issues, human papilloma virus infections, and other clinical data with a focus on relevant information such as localization, time from implant insertion to the development of the carcinoma, implant type and prosthetic rehabilitation. RESULTS: Twenty-one patients were diagnosed with PIOM. The male-to-female ratio was 1.625. The mean age of the patients was 60.42 ± 9.35 years old. Three patients reported ongoing alcohol/tobacco consumption. Five patients had a history of previous oral cancer surgery or exhibited mucosal lesions. The time from implant placement until carcinoma diagnosis was 49.13 ± 33.63 months on average. Most PIOM patients (95.2%) were diagnosed with SCC. All patients had previously been treated for peri-implantitis. In 85.7% of the patients, prostheses were observed on the opposing teeth where PIOM occurred. CONCLUSION: Based on the review of these cases, it can be deduced that there is a possibility that implant treatment and galvanic currents between prosthesis may constitute an irritant and/or inflammatory cofactor which contributes to the formation and/or development of malignant tumors. Patients at potential risk may benefit from individualized recall intervals and careful evaluations.

Oral cancer in pregnancy: A systematic review.

PURPOSE: Oral cancers in pregnancy (OCiP) are rare, however when diagnosed it complicates both the treatment of cancer and the outcome of pregnancy. The aim of this systematic review was to assess the factors impacting the foetal and maternal outcome in OCiP. MATERIALS AND METHODS: A systematic search was performed on the following electronic databases: PubMed, Scopus, ScienceDirect and Google Scholar. Only histopathologically diagnosed cases of oral cancer in pregnant patients were included. The Joanna Briggs Institute questionnaire for case reports was used to assess the risk of bias. Logistic regression analysis was used to assess the factors impacting foetal and maternal outcome. RESULTS: Out of the 40 cases reported, 28 were squamous cell carcinomas and 7 osteosarcomas. Logistic regression analysis demonstrated a non-significant association between age of patient, staging, trimester and treatment to maternal and foetal outcome. The overall recurrence, maternal death and foetal death for OCiP was 25 %, 30.77 % and 3.45 % respectively. CONCLUSION: It could be concluded with low evidence level that none of the factors explored in this SR affected the maternal and foetal outcome. A regular oral check-up, particularly the tongue of pregnant females is recommended to identify any early signs of inflammation or oral cancer and subjected to biopsy to identify malignancy or dysplasia.

Oral galvanism related to dental implants.

BACKGROUND: A range of different chemical interactions can generate an unexpected electronic current in a process called galvanism. Oral galvanism (OG) can also be generated by different chemical actions from diverse intraoral rehabilitated metals, including gold, copper, mercury, titanium, and titanium alloy. The main aim of this manuscript is to review OG, particularly focusing on titanium implants and related metallic materials. We searched the MEDLINE (PubMed), Embase, Scopus, and Google Scholar databases for relevant literature published through December 2019. The keywords included "galvanic current", "galvanism", "galvanic corrosion", "oral galvanism", combined with "oral", "oral cavity", "implant", and "saliva." RESULTS: Out of 343 articles, 126 articles that met the inclusion criteria were reviewed. We examined and summarized research on OG through a division into four categories: definition and symptoms, diagnosis with testing methods, galvanic corrosion, and oral precancerous lesions with OG. CONCLUSIONS: Patients with OG have high oral energy and current, and although this phenomenon may be due to the patient's mental illness, OG due to amalgam or mercury occurs. It is evident that the difference in electron potential caused by different elemental components such as titanium alloy and pure titanium, which are essential for manufacturing the implant fixture and the abutment, and chrome and nickel, which are essential for manufacturing the upper crown, causes OG. Since the oral cavity is equipped with an environment in which electric current can be transmitted easily due to saliva, it is imperative that clinicians review the systemic and local effects of salivation.

Evaluation of crystallization patterns in oral potentially malignant disorders and oral malignancies: A prospective study.

Background: Oral cancers are often detected at late stages, and patients usually had a 50% chance of a 5-year survival rate. Oral cancer usually has an early precancerous stage before its actual malignant transformation. Although there are various approaches to diagnose the early stages of cancer, there is one less explored, cost-effective, and simple technique known as the crystallization test. The aim of the study was to evaluate the crystallization patterns in tobacco users, oral potentially malignant disorders (OPMDs), and oral malignancies. Materials and Methods: Fifteen patients with oral malignancies, 15 patients with oral potentially malignant disorders, 15 tobacco users, and 15 healthy individuals participated in the crystallization test. Single blood drop was used to perform this test and the obtained crystal patterns were analyzed. Results: This test had a sensitivity of 93.3%, 80.0%, and 20.0% for oral malignancies, oral Potentially Malignant Disorders (PMDs), and tobacco users, respectively. Chi-square analysis revealed a highly significant transverse form between OPMDs and oral malignancies (P < 0.05). Conclusion: Crystallization test was found to be a sensitive, reliable, economical, and less invasive procedure for screening of oral PMDs and oral malignancies under strictly maintained physical conditions.

The lateral cervical stria approach to selective neck dissection: a preliminary study

Background: This study aims to propose a lateral cervical stria approach for selective neck dissection (SND) in patients of early-stage oral malignancies. Material and methods: The lateral cervical stria approach was used in 11 patients undergoing SND between December 2020 and March 2022. The surgical incision was located in submandibular cervical stria, with a length of 5.0 cm. The ipsilateral SND was performed according to the pathological type, covering part or all of I-V levels. Perioperative variables including operation time, blood loss, drainage volume, number of lymph node as well as complications were assessed. The score of appearance using the University of Washington Quality of Life Questionnaire (UW-QOL) was recorded 6-month postoperatively. Results: Direct closure of primary lesion was performed in ten patients and a forearm free flap reconstruction was used in one patient. No wound breakdown or infection was found in all cases. The mean operative time of SND was 157.63±27.39 min. The volume of intraoperative blood loss and postoperative drainage was 120.45±36.77 ml and 314.09±98.82 ml, respectively. The mean number of retrieved lymph nodes was 17.89±6.03 (ranging from 12 to 31). Postoperative complications included mild static lower lip deviation (n=1), shoulder discomfort (n=1) and mild auricular paraesthesia (n=1). The mean score of appearance was 86.36±13.06, with 100 scores in 5 patients and 75 scores in 6 patients. Conclusions: The lateral cervical stria approach for SND in early-stage oral malignancies is reliable, achieving to satisfactory functional and aesthetic outcomes. (AU)

Evaluation of total glutathione-s-transferase levels in serum of patients with oral malignancy.

Introduction: Squamous cell carcinoma-related antigen is not always sensitive enough for the early detection of oral cancer which is why a new marker has been desired as a substitute to be applied for serum diagnosis of oral cancer. Reactive oxygen species (ROS) has been known to play an important role in carcinogenesis. Glutathione-s-transferases (GSTs) are a family of eukaryotic and prokaryotic phase-II metabolic isoenzymes involved in xenobiotic detoxification. This correlation of the ROS species function and their role in initiation and progression of cancer could be exploited as of diagnostic value. The biologic function of the GSTs in human head-and-neck squamous cell carcinomas has been studied by researchers at gross as well as molecular levels. Taking into consideration this scientific background, future scope and perspectives, we initiated this study. Materials and Methods: This study was performed as a prospective case-control in vitro analytical study with subjects (n = 40) fulfilling the prerequisite conditions and were compliant. The case group (n = 20) was subjects with histopathologically proven cases of oral malignancy and age- and sex-matched control group (n = 20). The enzyme GST was evaluated in sera of all participants and then comparison was done between two groups as well as correlation with histopathologic grading for oral malignancy. Results: The mean serum GST activity in oral cancer patients was significantly higher than that of the control group. The present study has compared the alterations of enzyme in relation to histopathological grading of oral malignancy and found increased serum GST activity of well-differentiated and moderately differentiated carcinomas than the poorly differentiated carcinoma in terms of mean. Conclusion: Increased expression of the enzyme, as reported in the present study, can be due to tumor burden which attributes to overproduction of GST by cancer cells. The major clinical significance of the present study is that it gives important information regarding a new tumor progression and prognosis marker.

Association between tooth loss and risk of occurrence of oral cancer - A systematic review and meta-analysis.

Background: Periodontitis, the second most common reason for tooth loss in adults, is a chronic inflammatory condition that increases the prevalence of cancer by inhibiting apoptosis and promoting tumor cell growth. However, it is still debatable if tooth loss is an important risk factor in oral cancer (OC). The aim of this systematic review is to analyze the relationship between tooth loss and the probability of developing head-and-neck cancer and also to see if there is an association between tooth loss, periodontitis, and the risk of OC. Materials and Methods: Studies that depicted a link between tooth loss and OC (till 2017) were searched from online databases accompanied by a thorough manual search of relevant journals. Data were collected from eligible studies, and meta-analysis was carried out using the Meta-Analysis software. The effect of various inclusions was assessed by sensitivity and subgroup analysis. Publication bias was also evaluated. Results: The meta-analysis consisted of 15 publications. When the number of teeth lost was counted, there was significant variability (I2 = 98.7%, P = 0.0001). When more than 15 teeth were missing in a subgroup analysis, there was a 2.4 times greater risk of OC (odds ratio: 2.496, 95% confidence interval [CI] = 2.067-3.015, P = 0.001) with no heterogeneity (I2 = 0.00%, 95% CI for I2 = 0.00-68.98). Subgroup analysis revealed that there was no evidence of publication bias. Conclusion: It was concluded that tooth loss can increase the OC risk by nearly 2 folds. However, large-scale population-based studies are needed to substantiate the findings.

Bioinformatics analysis of miRNA and its associated genes to identify potential biomarkers of oral submucous fibrosis and oral malignancy.

BACKGROUND: MicroRNAs are a group of non-coding RNA that controls the gene expression. The interaction between miRNA and mRNA is thought to be dynamic. Oral cancer "The cancer of mouth" is quite prevailing in developing countries. miRNA has been found associated with oral cancer targeting tumor growth, cell proliferation, metastasis, invasion. The significant association of miRNA with genes could be used as a remarkable tool for diagnosis as well as prognostic analysis of oral cancer. AIM: The aim of the present study is to evaluate common upregulated and downregulated miRNAs in oral submucous fibrosis (OSMF) and oral malignancy (OM) patients that can be used as diagnostic biomarkers, and to find out their interactions with target genes to establish associated networks in cancer pathways. METHODS AND RESULTS: Using miRDeep2 and DESeq analysis, the upregulated and downregulated miRNA in OSMF (Oral Submucous Fibrosis) and OM (Oral Malignancies) samples were compared to GEO (Gene Expression Omnibus) control dataset. There were 50 common downregulated miRNAs and 13 common upregulated miRNAs in OSMF and OM samples. miRNet analysis of common upregulated miRNA and common downregulated miRNA identified 1295 and 5954 genes, respectively connected with cancer pathways. From analysis of Hub genes, HRAS, STAT3, TP53, MYC, PTEN, CTNNB1, CCND1, JUN, VEGFA, KRAS were found associated with downregulated miRNA and VEGFA, TP53, MDM2, PTEN, MYC, ERBB2, CDKN1A, HSP90AA1, CCND1, AKTI were found associated with upregulated miRNA. The gene enrichment analysis of these hub genes were associated with cell communication, metabolic process, cell proliferation, and cellular component organization. Hub Genes linked with upregulated miRNA had an enrichment ratio of 11.828, whereas hub genes linked with downregulated miRNA had an enrichment ratio of 45.912. CONCLUSION: We identified common deregulated miRNAs between OSMF and OM patients, which were further analyzed to find out associations with the genes correlated to cancer pathways. The hub genes identified in this study were found to have a significant impact on tumor growth and carcinogenesis. Also, the enrichment of these genes has revealed that the genes are associated with cellular communication, metabolic processes and various biological regulation. These deregulated miRNAs can be used to make a panel of biomarkers to diagnose oral cancer from blood even before its onset.

Salivary Exosomal MicroRNA-486-5p and MicroRNA-10b-5p in Oral and Oropharyngeal Squamous Cell Carcinoma.

Background and Objectives: The research aimed at evaluating the capacity of salivary exosomal miR-10b-5p and miR-486-5p for oral and oropharyngeal cancer detection. Materials and Methods: The saliva samples were harvested from histopathological diagnosed oral and oropharyngeal squamous cell carcinoma patients and healthy volunteer subjects. The exosomes were isolated by differential ultracentrifugation and quantified by Nano Track Analysis. The microRNAs were extracted and quantified from salivary exosomes by quantitative Real-Time Polymerase Chain Reaction. Results: This research comprised fifty participants. When compared to healthy controls, salivary exosomal miR-486-5p was elevated and miR-10b-5p was reduced in oral and oropharyngeal squamous cell carcinoma. Moreover, miR-486-5p had a high expression level in stage II of cancer in comparison to the other cancer stages. The cancer samples presented an increased exosome dimension compared to the control samples. Conclusions: Salivary exosomal miR-10b-5p and miR-486-5p have an altered expression in oral and oropharyngeal cancer.

Combined Use of Pectoralis Major Myocutaneous Flap and Deltopectoral Flap for the Reconstruction of Advanced Oral Cancers: Our Experience in 29 Cases.

Purpose: To assess the utility of the combined use of pectoralis major myocutaneous (PMMC) flap and deltopectoral flap (DP) in advanced oral cavity cancers in the Indian population. Materials and Methods: It is a retrospective study, considering 29 patients with stage IV carcinoma of the oral cavity, from July 2015 to February 2019. Both pectoralis major Myocutaneous flaps and deltopectoral flaps were used for stage IV oral cancers involving the full-thickness cheek and the mandibular cortex. The reliability of the flaps and clinical outcomes were evaluated in the postoperative period. Results: Of the 29 patients, partial necrosis of the skin island was detected in 6 patients, 2 patients presented with wound dehiscence, and one patient had an orocutaneous fistula. Recurrence was detected in 3(10.34%) patients, in one patient, it was at the primary site and in 2 patients, it was in the neck. When different parameters were compared between the patients with complications and without complications, the comorbidities like smoking and alcohol intake adversely affected the flap survival in the postoperative period. Conclusions: The combined use of PMMC and DP flap can be a reliable option for advanced oral malignancies, especially in patients with poor performance status with the coexisting chronic illness. Due to the presence of a definite vascular pedicle, ease of harvesting the flap, quick surgical procedure, and the minimal postoperative morbidities, these pedicle flaps can be successfully used alternative to the free flaps in advanced oral cancers, especially patients with a low socioeconomic corridor like India.

Is It Time to Consider Implementation of Telemedicine in Current Oral Health Care Services?

Telemedicine offers an excellent opportunity to provide continuing health care for those in need during local/global pandemics and disasters. It provides a safe and effective communication tool between health professionals and can be used as "forward triage" to manage medical/dental emergencies and to minimize the contact between the patients and clinicians during the coronavirus disease (COVID-19) pandemic. Patients with noncommunicable diseases, like cancer, diabetes, cardiovascular, or chronic respiratory diseases, may present with critical health problems due to less access to health care systems during global disasters; opportunities for screening oral mucosa might be significantly disrupted, leading to delayed diagnosis of malignant/potentially malignant lesions. Telemedicine and oral health care associated mobile applications should be implemented to provide equal access to care, to eliminate unnecessary visits to health centers, and to improve practical coordination between professionals and health facilities.

Necrotizing Sialometaplasia: A Diagnostic Challenge to Oral Physicians.

Necrotizing sialometaplasia is a rare, reactive, self-limiting disorder affecting a minor salivary gland that clinically mimics malignancy. Chronic smoking, alcohol use, trauma to the hard palate caused by local anesthetic injection due to the vasoconstrictive action of adrenaline in local anesthetic, topical application of nonsteroidal anti-inflammatory drugs like flurbiprofen spray used in bronchial asthma, oral intubation procedures for general anesthesia, ill-fitting dentures, bulimia nervosa, and minor salivary gland tumors are some of the contributing factors linked to its development. In this article, we discuss a rare, reactive, self-limiting condition affecting minor salivary gland, necrotizing sialometaplasia that occurred on the right posterolateral hard palate region in a 57-year-old male chronic smoker, diagnosed by oral medicine specialist by clinical findings and radiological evaluation by cone beam computed tomography that healed rapidly in three days by itself without any treatment, that prevented unwanted biopsy or surgery.

Clinical application of the mixed reality technique to assist the location and anatomy of perforator vessels of the anterolateral femoral flap / 口腔疾病防治

Objective@#To explore the clinical application value of mixed reality technology in locating perforator vessels and assisting perforator vessel dissection to harvest anterolateral thigh flaps.@*Methods@#Six patients who needed anterolateral thigh flap repair after resection of oral and maxillofacial tumors were recruited from the Department of Oral and Maxillofacial Surgery of Nanchong Central Hospital from January 2020 to January 2021. Before surgery, the CT angiography data of the lower limbs of the patients carrying the calibration points were imported into the data workstation to perform 3D reconstruction of the perforator vessels and surrounding tissues of the thigh, and the reconstruction results were imported into Microsoft HoloLens 2 glasses. During the operation, calibration was performed at the calibration point of the operative area so that the preoperative reconstruction results were superimposed on the operative area through Microsoft HoloLens 2 glasses. The clinical application value of mixed reality technology assisted perforator vessel location and anatomy of anterolateral femoral perforator flap was discussed from six aspects: whether the perforator vessel was reconstructed preoperatively, intraoperative calibration time, whether the actual position of the perforating vessels passing through the fascia lata fulcrum deviated from the preoperative reconstruction result within 1 cm, time required to harvest the flap, and whether the actual route of the perforator vessel was consistent with the reconstruction result, and whether the postoperative flap survived.@*Results @# The position and course of perforating vessels were successfully reconstructed in 6 cases before the operation. The actual course of perforating vessels during the operation was consistent with the reconstruction results. The deviation between the actual position of the perforating points and the preoperative reconstruction results was within 1 cm, which met the requirements of the actual asisting of the anterolateral thigh flap. The average time of flap harvest was (70.50 ± 7.20) min. The average calibration time was (13.33 ± 5.50) min. All flaps survived.@* Conclusions @# Mixed reality technology projects the reconstruction results of anterolateral femoral perforator vessels directly into the operative area, which provides a new method for asisting localization and anatomy of anterolateral femoral flap perforator vessels and reduces the possibility of injury to perforator vessels.

Clinical Approach to Decision-Making in Nasogastric Tube Weaning and Tracheostomy Tube Decannulation.

Extensive resections for advanced malignancies of the oral cavity quite often require patients to have a tracheostomy tube and nasogastric tube for prolonged periods leading to dependence. Timely and safe removal of these tubes would help hasten the recovery and rehabilitation of these patients. A simple bedside protocol for evaluation and weaning of nasogastric tube and tracheostomy tube is outlined in this communication. This would help health care workers in resource-poor settings make safe clinical decisions and improve care.

Rehabilitation of squamous cell carcinoma defect with two-piece hollow bulb obturator prosthesis - A case report.

Two-piece hollow bulb obturator maxillofacial prosthesis for hemi-maxillectomy defect is given after surgical resection due to oral squamous cell carcinoma. Maxillofacial prosthodontists play a pivotal role in construction of prosthesis. Unique choices are made in prosthesis design depending on the clinical representation. Improvement in function, phonetics and esthetics was appreciated.