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Purpose: Evaluate the occupational variation in incidence of oropharyngeal cancer (OPC). Methods: We calculated standardized incidence ratios (SIRs) of OPC in occupational categories in the Nordic countries relative to the entire national populations. The data covered 6155 OPC cases. Results: Among men high risk of OPC was observed, among else, in waiters (SIR 6.28, 95% CI 4.68–8.26), beverage workers (SIR 3.00, 95% CI 1.72–4.88), and artistic workers (SIR 2.97, 95% CI 2.31–3.76). Among women high risk of OPC was observed in waiters (SIR 2.02, 95% CI 1.41–2.81) and packers (SIR 1.73, 95% CI 1.07–2.64). The lowest SIRs were observed in female gardeners (SIR 0.27, 95% CI 0.12–0.51) and male farmers (SIR 0.30, 95% CI 0.25–0.35). Conclusion: The 20-fold variation in incidence of OPC between occupations needs further investigation in studies with detailed information on occupational and non-occupational risk factors. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with head and neck squamous cell carcinoma (HNSCC) might present with different clinical behaviors, even when classified at the same stage. This perspective highlights the recent findings on prognostic biomarkers that can aid in improving the staging of HNSCC. This was conducted with an aim of subsequently improving prognostic stratification and, hence, treatment planning. Tumor-node-metastasis (TNM) staging system is the cornerstone for treatment planning of head and neck squamous cell carcinoma (HNSCC). Many prognostic biomarkers have been introduced as modifiers to further improve the TNM classification of HNSCC. Here, we provide an overview on the use of the recent prognostic biomarkers, with a focus on histopathologic parameters, in improving the risk stratification of HNSCC and their application in the next generation of HNSCC staging systems. [ABSTRACT FROM AUTHOR]

Background: Insufficient preoperative work-up and consequent intralesional or marginal resection of soft-tissue sarcomas of the head and neck (STSHNs) is common. Methods: This retrospective cohort study comprised 63 patients with STSHN treated at the Helsinki University Hospital between 2005 and 2017. We assessed the effect of pretreatment tumor sampling on surgical margin status and need for supplemental surgery, as well as prognostic factors and survival. Results: The lack of representative pretreatment biopsy specimen was associated with unfavorable margin status. Primary surgery at a non-academic center was associated with need for supplemental surgery. The 3-year overall survival (OS) was 68%, disease-specific survival (DSS) 71%, and recurrence-free survival (RFS) 61%. Higher tumor grade and primary tumor size over 5 cm were associated with reduced DSS. Conclusions: Diagnosis and management of STSHNs should be centralized to experienced academic centers. Decision-making between needle biopsy, open biopsy, or upfront radical surgery depends on tumor location and size. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown an increased prevalence of candidiasis in patients receiving radiotherapy for head and neck cancer. However, little is known of the effect the different cancer treatment modalities have on the oral Candida status.Objective and Hypothesis: The objective of this study was to investigate the change in salivary Candida status of oral squamous cell carcinoma (OSCC) patients undergoing cancer treatment. The hypothesis was that cancer treatments change the oral microbial environment favouring an increase in the prevalence of more pathogenic non-albicans Candida (NAC).Methods: We collected paraffin-stimulated saliva from 44 OSCC patients before surgery and after a minimum of 19 months of follow-up. Chromagar, Bichro-Dupli-test and API ID 32 C were used for identification of different Candida species and results were analysed statistically.Results: At both timepoints, 75% of samples were Candida positive with C. albicans being the most common yeast. NAC strains were present in 16% of the pre-operative samples and 14% of the follow-up samples. The NAC species found were C. dubliniensis, C. krusei, C. guilliermondii (preoperatively only) and C. glabrata (at follow-up only). In 73% of the cases, the salivary Candida status remained unchanged. There was an 18% increase in the prevalence of candidiasis. However, the different treatment modalities did not statistically significantly affect the Candida status of the patients.Conclusion: The intraindividual prevalence of salivary Candida among OSCC patients seems to be stable and different treatment modalities have little to no effect on the salivary Candida status. [ABSTRACT FROM AUTHOR]

Background and aims: Stage II cancer of the tongue is mostly managed surgically both locally and regionally. However, indications for postoperative radiotherapy and reconstructive options vary between centers. This paper aims to describe differences in treatment in a geographically homogenous cohort. Methods: A retrospective comparison was made between two cohorts of clinical T2N0 tongue cancer from Finland and Sweden. The Finnish cohort included 75 patients and the Swedish 54. All patients had curative intent of treatment and no previous head and neck cancer. Data analyzed consisted of pathological stage, size and thickness of tumor, frequency of reconstruction, radiotherapy delivered, and survival. Results: The Finnish cohort included a higher proportion of patients managed with reconstructive surgery (67%) than the Swedish cohort (0%), p <.00001. More patients were treated with postoperative radiotherapy (84%) in the Swedish cohort than in the Finnish (54%), p <.0002. The Finnish cohort had a higher level of survival and included more frequent downstaging (cTNM to pTNM). Conclusions and significance: Our data indicate a major difference in the management of T2N0 oral tongue cancer. The optimal cut-off size and growth pattern of the tumor warranting reconstruction should be further evaluated in a prospective manner considering both survival and quality of life. [ABSTRACT FROM AUTHOR]

Background and aims: Stage II cancer of the tongue is mostly managed surgically both locally and regionally. However, indications for postoperative radiotherapy and reconstructive options vary between centers. This paper aims to describe differences in treatment in a geographically homogenous cohort. Methods: A retrospective comparison was made between two cohorts of clinical T2N0 tongue cancer from Finland and Sweden. The Finnish cohort included 75 patients and the Swedish 54. All patients had curative intent of treatment and no previous head and neck cancer. Data analyzed consisted of pathological stage, size and thickness of tumor, frequency of reconstruction, radiotherapy delivered, and survival. Results: The Finnish cohort included a higher proportion of patients managed with reconstructive surgery (67%) than the Swedish cohort (0%), p < .00001. More patients were treated with postoperative radiotherapy (84%) in the Swedish cohort than in the Finnish (54%), p < .0002. The Finnish cohort had a higher level of survival and included more frequent downstaging (cTNM to pTNM). Conclusions and significance: Our data indicate a major difference in the management of T2N0 oral tongue cancer. The optimal cut-off size and growth pattern of the tumor warranting reconstruction should be further evaluated in a prospective manner considering both survival and quality of life. [ABSTRACT FROM AUTHOR]

Background: Cancers of the head and neck have a high mortality rate, and roughly 10% of the patients die within six months of diagnosis. To our knowledge little has been written about this group. We wished to identify risk factors for early death, to predict and monitor patients at risk better and, if possible, avoid unjustified major treatment. Methods and findings: This population-based nationwide study from the Swedish Head and Neck Cancer Register (SweHNCR) included data from 2008–2015 and 9733 patients at potential risk of early death. A total of 925 (9.5%) patients died within six months. For every year older the patients became, the risk of early death increased by 2.3% (p<0.001). The relative risk of death was 3.37 times higher (237%) for patients with WHO score 1 compared with WHO score 0. A primary tumour in the hypopharynx correlated with a 24% increased risk over the oral cavity (p<0.024). Patients with stage IV disease had a 3.7 times greater risk of early death than those with stage I (p<0.001). As expected, a 12 times increased risk of early death was noted in the palliative treatment group, compared to the curative group. Limitations to this study were that the actual cause of death was not recorded in the SweHNCR, and that socioeconomic factors, alcohol consumption, smoking habits, and HPV status, were not reported in SweHNCR until 2015. However, the fact that this is a population-based nationwide study including 9733 patients compensates for some of these limitations. Conclusions: Identification of patients at increased risk of early death shows that older patients with advanced disease, increased WHO score, primary tumour in the hypopharynx, and those given palliative treatment, are more likely than the others to die from head and neck cancer within six months of diagnosis. [ABSTRACT FROM AUTHOR]

Background: No blood biomarkers to detect early oral cavity squamous cell carcinoma (OSCC) without clinical signs exist - diagnosis is solely based on histology of a visible tumour. Most OSCC patients are diagnosed at advanced stage, which leads to significant morbidity and poor survival. Our aim was to find the serum screening or detection biomarkers in OSCC.Methods: Serum samples from patients with OSCC treated at the Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital (Finland) were collected. Age- and gender-matched healthy individuals served as controls. Quantitative label-free proteomics in high definition MSE mode(HDMSE) was performed on 13 patients and 12 healthy samples. Various statistical analyses were performed on quantitative proteomics data to obtain the most influential proteins, which classify the patients vs healthy samples.Results: In quantitative proteomic analysis (HDMSE), 388 proteins were quantified in our pilot study. A complete separation between cases and controls was seen in supervised and unsupervised classification techniques such as orthogonal projections on latent structure-discriminant analysis (OPLS-DA) and self-organising maps. Using OPLS-DA S-plot, we identified a set of eight proteins that completely separated OSCC patients from healthy individuals.Conclusions: Although the tumour stages varied from I to IVa, these potential biomarkers were able to identify all OSCCs demonstrating their sensitivity to detect tumours of all stages. We are the first to suggest a set of serum biomarkers in our pilot study to be evaluated further as a diagnostic panel to detect preclinical OSCC in risk patients. [ABSTRACT FROM AUTHOR]

Tinnitus is an auditory phantom sensation which can be a devastating condition for the affected person causing annoyance and discomfort. It may be associated with psychiatric conditions. Patients with highly annoying tinnitus and different comorbidities may have a higher risk of expressing suicidal behaviour and ideation. We aimed to review available reports on the prevalence of suicide and suicidal behaviour with tinnitus patients in order to collate current concepts and to identify possible alarming signs and risk factors. A comprehensive search for appropriate studies listed in PubMed, Ovid and Cochrane databases was conducted using appropriate keyword combinations. We identified 22 publications including original articles, case reports and reviews of which 10 fit our stringent search criteria. Most importantly, from the present studies it appears not feasible to univocally conclude on the co-incidence of tinnitus and suicide. This is due to methodological differences in these approaches, complex interrelations between tinnitus and other psychiatric comorbidities and confounding factors such as the inclusion of patients suffering from post-traumatic stress disorder. More concerted actions involving different medical disciplines are needed to reflect the ethiological heterogeneity of tinnitus and suicide or suicidal behaviour to test for a relationship. [ABSTRACT FROM AUTHOR]

• Optimal treatment for T2-3 laryngeal squamous cell carcinoma (LSCC) is undecided. • Bayesian network (BN) model is used for estimation of treatment outcome from observational data. • BN gives a possibility to control for multiple variables with complex dependences. • A novel method of disjunctive confounder criterions is adapted. • Locoregional control was better in T2-3 LSCC patients who underwent surgery. [ABSTRACT FROM AUTHOR]

Ferroptosis is an iron-dependent regulatory form of cell death characterized by the accumulation of intracellular reactive oxygen species and lipid peroxidation. It plays a critical role not only in promoting drug resistance in tumors, but also in shaping therapeutic approaches for various malignancies. This review aims to elucidate the relationship between ferroptosis and head and neck cancer treatment by discussing its conceptual framework, mechanism of action, functional aspects, and implications for tumor therapy. In addition, this review consolidates strategies aimed at improving the efficacy of head and neck cancer treatment through modulation of ferroptosis, herein serving as a valuable reference for advancing the treatment landscape for this patient population. [ABSTRACT FROM AUTHOR]

Background A remarkable development through the evolution of free flap techniques has led to themodern reconstructive head and neck surgery. This study aimed to review experiences from head and neck free-flap reconstructions performed at our institution over an 18-year period. Methods Between 1995 and 2012, 594 free-flap operations were performed on 541 head and neck patients at the Department of Plastic Surgery, Helsinki University Hospital, Finland. We retrospectively recorded hospital chart data regarding patient demographics, tumor characteristics, surgical treatment, and outcome. Results The mean age of patients increased from 53 years (1995-2000) to 56 (2007-2012), while the gender distribution remained constant (60% males). The most commonly used flap type between 1995 and 2000 was radial forearm flap (50%), while during the periods of 2001 through 2006 and 2007 through 2012 the anterolateral thigh flap was the most common method (42 and 36%, respectively). The number of different flap types and flap combinations increased during these periods (15 flap types during 1995 through 2000; 17 flap types during 2001 through 2006; and 24 flap types during 2007 through 2012). Despite a wider range of flap options used during the period 2001 through 2012, the overall flap survival rate (97%) remained constant. The prevalence of surgical complications decreased from 26% (2001 through 2006) to 21% (2007 through 2012). Conclusions During the study period, the number of flap types increased and reconstructions became more individualized. The overall surgical complication rate decreased although the mean age of patients increased. [ABSTRACT FROM AUTHOR]

Transcranial direct current stimulation (tDCS) has shown potential for providing tinnitus relief, although positive effects have usually been observed only during a short time period after treatment. In recent studies the focus has turned from one-session experiments towards multi-session treatment studies investigating long-term outcomes with double-blinded and sham-controlled study designs. Traditionally, tDCS has been administered in a clinical setting by a healthcare professional but in studies involving multiple treatment sessions, often a trade-off has to be made between sample size and the amount of labor needed to run the trial. Also, as the number of required visits to the clinic increases, the dropout rate is likely to rise proportionally.The aim of the current study was to find out if tDCS treatment for tinnitus could be patient-administered in a domiciliary setting and whether the results would be comparable to those from in-hospital treatment studies. Forty-three patients with chronic (> 6 months) tinnitus were involved in the study, and data on 35 out of these patients were included in final analysis. Patients received 20 minutes of left temporal area anodal (LTA) or bifrontal tDCS stimulation (2 mA) or sham stimulation (0.3 mA) for ten consecutive days. An overall reduction in the main outcome measure, Tinnitus Handicap Inventory (THI), was found (mean change −5.0 points, p < 0.05), but there was no significant difference between active and sham treatment outcomes. Patients found the tDCS treatment easy to administer and they all tolerated it well. In conclusion, self-administered domiciliary tDCS treatment for tinnitus was found safe and feasible and gave outcome results similar to recent randomized controlled long-term treatment trials. The results suggest better overall treatment response—as measured by THI—with domiciliary treatment than with in-hospital treatment, but this advantage is not related to the tDCS variant. The study protocol demonstrated in the current study is not restricted to tinnitus only. [ABSTRACT FROM AUTHOR]

Hypopharyngeal squamous cell carcinoma (HSCC) is treated by definitive concomitant chemoradiotherapy at most centres. Intensity-modulated radiotherapy (IMRT) is an advanced computer-controlled high-precision radiotherapy technique that has been used at our institution in the treatment of HSCC since 2002. Our aim was to review the treatment results of IMRT-based chemoradiotherapy (CRT) in patients diagnosed with HSCC. The cohort comprised all patients with previously untreated, biopsy-proven squamous cell carcinoma of the hypopharynx treated by definitive CRT using IMRT between March 2002 and November 2010. All patients were diagnosed M0. Forty-five eligible patients were identified. Six patients were treated by radiotherapy alone and 39 patients received concomitant chemotherapy. All patients had a minimum follow-up of 3 years or until death. Complete response was achieved in 29/45 (64 %) patients. Salvage surgery was performed on 10/16 patients with incomplete response. The 5-year estimates for overall survival, disease-specific survival, and local control in the whole cohort were 31, 45, and 64 %, respectively. Classifications T4 and N2c-N3 were prognostic for worse survival. None of the surviving patients needed permanent tracheotomy or PEG tube. We conclude that survival after IMRT-based CRT remained unsatisfactory with frequent relapses at distant sites. The outcome figures were comparable with those that have been achieved by surgery and postoperative radiotherapy. However, all the surviving patients in the current study cohort could retain their functioning larynx. These results using IMRT-based definitive CRT as the primary option for the treatment of HSCC support its continued usage for the delivery of radiotherapy. [ABSTRACT FROM AUTHOR]

The original article can be found online at https://doi.org/10.1007/s00405-021-07162-0. Correction to: European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-021-... In the original publication of the article, affiliation 1 was published incorrectly and the correct affiliation 1 should read as below, Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland In addition, under funding section, the university name should read as "Helsinki University Hospital" instead "Helsinki University Central Hospital". [Extracted from the article]

While certain occupations, such as agriculture and fishery, have been associated with an increased risk of lip cancer, the occupational risk profile of lip cancer and its change over time remain poorly known. This study aims to evaluate the incidence of lip cancer across different occupations in the Nordic countries. The Nordic Occupational Cancer Study (NOCCA) covers 14.9 million people and includes 45 years of cancer incidence data, from 1961 to 2005, linked to occupational categories for all the five Nordic populations. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were used to quantify the risk of lip cancer across occupational categories relative to the entire national populations. There were a total of 14,477 male and 3008 female lip cancer patients identified during follow up. The highest SIRs were observed among male fishermen (SIR 2.26, 95% CI: 2.04–2.50), gardeners (SIR 1.60, 95% CI: 1.48–1.72), and farmers (SIR 1.60, 95% CI: 1.55–1.66). A significantly reduced risk of lip cancer (SIR < 0.50) was observed among male physicians, teachers, religious workers, artistic workers, journalists, administrators, printers, waiters, and hairdressers. Among women, no occupations were associated with an increased risk of lip cancer. The incidence of lip cancer varies widely between outdoor and indoor occupations. Occupations involving outdoor activity and exposure to sunlight show the most elevated SIRs. Certain outdoor occupations, such as agriculture and fishery, have been associated with an increased risk of lip cancer. However, the occupational risk profile of lip cancer and its change over time remain poorly known. This study highlights the excess risk of lip cancer among men with outdoor occupations and further corroborates previous studies. Efforts to counsel outdoor workers on the risk and prevention of lip cancer are needed to reduce the societal burden of the disease. [ABSTRACT FROM AUTHOR]

Backgrounds Second branchial cleft anomalies predispose to recurrent infections, and surgical resection is recommended as the treatment of choice. There is no clear consensus regarding the timing or surgical technique in the operative treatment of these anomalies. Our aim was to compare the effect of age and operative techniques to patient characteristics and treatment outcome. Methods A retrospective study of pediatric patients treated for second branchial sinuses or fistulae during 1998-2012 at two departments in our academic tertiary care referral center. Comparison of patient characteristics, preoperative investigations, surgical techniques and postoperative sequelae. Results Our data is based on 68 patients, the largest series in the literature. One-fourth (24%) of patients had any infectious symptoms prior to operative treatment. Patient demographics, preoperative investigations, use of methylene blue, or tonsillectomy had no effect on the surgical outcome. There were no re-operations due to residual disease. Three complications were observed postoperatively. Conclusions Our patient series of second branchial cleft sinuses/fistulae is the largest so far and enables analyses of patient characteristics and surgical outcomes more reliably than previously. Preoperative symptoms are infrequent and mild. There was no difference in clinical outcome between the observed departments. Performing ipsilateral tonsillectomy gave no outcome benefits. The operation may be delayed to an age of approximately three years when anesthesiological risks are and possible harms are best avoided. Considering postoperative pain and risk of postoperative hemorrhage a routine tonsillectomy should not be included to the operative treatment of second branchial cleft fistulae. [ABSTRACT FROM AUTHOR]

Conclusions: This study demonstrates proof of concept for controlled manufacturing methods that utilize novel tailored biopolymers (3D photocuring technology) or conventional bioresorbable polymers (fused deposition modeling, FDM) for macroscopic and microscopic geometry control. The manufactured scaffolds could be suitable for tissue engineering research. Objectives: To design novel trachea scaffold prototypes for tissue engineering purposes, and to fabricate them by additive manufacturing. Methods: A commercial 3D model and CT scans of a middle-aged man were obtained for geometrical observations and measurements of human trachea. Model trachea scaffolds with variable wall thickness, interconnected pores, and various degrees of porosity were designed. Photocurable polycaprolactone (PCL) polymer was used with 3D photocuring technology. Thermoplastic polylactide (PLA) and PCL were used with FDM. Cell cultivations were performed for biocompatibility studies. Results: Scaffolds of various sizes and porosities were successfully produced. Both thermoplas PEA and PCL and photocurable PCL could be used effectively with additive manufacturing technologies to print high-quality tubular porous biodegradable structures. Optical microscopic and SEM images showed the viability of cells. The cells were growing in multiple layers, and biocompatibility of the structures was shown. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Otoplasty is the most common aesthetic surgical procedure performed in children. The goals for auricular surgery and the proportions of an aesthetically pleasing ear appear to be based on the aesthetic opinions of individual surgeons rather than on evidence-based data. Our study aimed to determine whether identifying an aesthetically pleasing auricle is possible. Methods: We used digital photographs of 29 auricles, a standardized camera setup, a panel of 20 plastic surgeons, and a visual analogue scale (VAS). We then analyzed the scores assigned by the panel for mean, median, standard deviation, analysis of variance, Tukey–Kramer Multiple Comparison Test, and Top 5 rankings. Results: Ranking by the panel was statistically significant (p <0.000001). Conclusions: It is possible to statistically rank the aesthetics of auricles, although it is difficult to identify the structural details that made an auricle aesthetically pleasing. [Copyright &y& Elsevier]

Sinonasal cancer is still a somewhat controversial entity because most series are single-center studies. The aim of this study was to give more accurate and generalisable information about treatment of the neck and prognosis of sinonasal cancer. Retrospective, population-based, multicentre study. Altogether 244 patients diagnosed in 1990-2004 were evaluated. The 3- and 5-year disease-specific survival (DSS) rates after treatment with curative intent were 68 and 57%, respectively. Regional status at the time of the diagnosis ( P < 0.001, log rank) and local recurrence ( P = 0.02, log rank) during the follow-up had a statistically significant effect on DSS. Initially 13% of the patients were diagnosed with neck metastasis. The proportion of regional recurrences during the follow-up was 9%, but it did not have a statistically significant impact on DSS ( P = 0.68, log rank). Histopathology had no statistically significant impact on survival in this material of 244 patients. In conclusion, routine elective neck treatment of all sinonasal cancer patients is not recommended, but the importance of the treatment of the primary location is emphasised. [ABSTRACT FROM AUTHOR]

Abstract: A poly(dl-lactic-co-glycolic acid) (PLGA) sandwiched adipose derived stem cell (ADSC)/fibrin tubular construct, fabricated using a step-by-step mold/extraction method, was characterized in this work. The ADSCs were also induced into smooth-muscle-like cells using growth factors such as hepatocyte growth factor (HGF), platelet-derived growth factor BB (PDGF-BB), transforming growth factor β1 (TGFβ1), and basic fibroblast growth factor (b-FGF). Compared with the non-induced cells, the proliferation ability of induced cells was much smaller. The PLGA sandwiched cell/hydrogel construct was shown to be useful for controlling the cellular microenvironment and cellular behaviors such as growth, migration, proliferation and differentiation. This strategy seems promising in tissue engineering and organ manufacturing. [Copyright &y& Elsevier]

We report a rare case of bilateral basal cell adenocarcinoma (BcAC) of the parotid gland in a male patient 30 years after kidney transplantation and continuous administration of immunosuppressive therapy. BcAC is a salivary gland malignancy first recognized as a distinct neoplastic entity in WHO classification of salivary gland tumours in 1991. Over 90% of BcACs are detected in the parotid gland. The most important differential diagnosis is basal cell adenoma. Infiltrative growth is the distinguishing feature of BcAC. Administration of immunosuppressive medication to this patient for three decades may have contributed to development of this rare neoplasia. To our knowledge, similar cases of BcAC have not been reported previously. [ABSTRACT FROM AUTHOR]

Conclusions. This study found a 0.8% incidence of non-cutaneous head and neck cancer during a mean follow-up of 10 years. The benefits of successful renal transplantation clearly outweigh the observed risk of malignancy. Objective. Increased cancer incidence after organ transplantation is well documented but few studies have reported on the rate of head and neck malignancies among these patients. This study aimed to determine the incidence and specific sites of head and neck cancer in a nationwide series of renal transplant patients in Finland. Patients and methods. Data from the National Kidney Transplant Registry and the Finnish Cancer Registry were used. A total of 2884 kidney transplant patients from the period 1964 to 1997 were followed for cancer incidence during the period from 1967 to 2003. Results. There were 113 non-lymphomatous head and neck malignancies. The standardized incidence ratio (SIR), as compared with the general population, was 13.6, with a 95% confidence interval (CI) of 11.2-16.2. The SIR was significantly elevated for cancers of the skin (47.3, 95% CI 36.3-60.7), lip (31.8, 95% CI 20.8-46.6), oral cavity (6.5, 95% CI 2.4-14.0) and thyroid (5.8, 95% CI 3.0-10.2). [ABSTRACT FROM AUTHOR]

Fibrous dysplasia (FD) is a benign skeletal disorder which may affect one or multiple bones. Lesions often involve long bones, ribs, and craniofacial bones and cause pain, fractures, and disfigurement. We describe an adolescent girl with mandibular FD who was successfully treated with bisphosphonates. She presented with a tumor-like lesion of the mandible. During the 2-year follow-up, the lesion expanded and caused significant disfigurement and pain necessitating psychiatric support. Treatment with bisphosphonate administered intravenously resulted in rapid pain relief, normalization of bone turnover, and cosmetic improvement. Management of FD has previously consisted of either conservative follow-up or surgery depending on disease activity and localization. Based on published reports and our experience, bisphosphonates should be considered in the treatment of symptomatic cases. This line of treatment may be suitable especially for craniofacial FD in which surgical treatment is particularly challenging. [ABSTRACT FROM AUTHOR]

Management of oral tongue squamous cell cancer (OTSCC) remains a challenge. This nationwide study reports the used treatment approach and the outcome of OTSCC in Finland. Retrospective study of OTSCC patients in 1995–1999 with a 5-year follow-up. The corresponding data from 1980 to 1989 is also included. About 235 patients (125 M, 110 F; mean age 61.6 years; range 24–90 years) were included, 77% had SCC of lateral border of the tongue and 25% were N+. Treatment with curative intent was given to 224 (95%) patients. Surgery of the primary tumour was performed in 218 (97%) patients and with a reconstruction in 69 (31%) patients. A neck dissection was performed ipsilaterally in 114 (51%) and bilaterally in 9 (4%) cases. Irradiation was given to 131 (58%) patients. The rate for locoregional recurrence was 28%. The 3- and 5-year overall survival (OS) rates were 66 and 47%, respectively. The corresponding disease specific survival (DSS) rates were 74 and 64%, respectively. The mean DSS for patients younger than 40 years and older than 40 years was 111 and 88 months, respectively ( P < 0.02). The 3- and 5-year DSS rates were: Stage I, 88 and 74%; Stage II, 74 and 62%; Stage III, 79 and 71% and Stage IV, 36 and 33%, respectively. In the present study the surgical treatment approach seems effective in controlling early stage OTSCC but the modest survival, in spite of combination of radiotherapy and surgery, points out the need to consider new strategies in the management of advanced stage disease. [ABSTRACT FROM AUTHOR]

Bipolar radiofrequency induced thermotherapy (RFITT) is a minimally invasive electrosurgical technique characterized by a precise controllable effect in the tissue. It has demonstrable efficacy, safety and reproducibility in the management of solid malignancies. Our aim was to assess the morbidity and efficacy of RFITT as a palliative treatment of head and neck cancer. Prospective, non-randomized case series and analysis. After evaluation by the multidisciplinary Head and Neck Tumour Board at Helsinki University Central Hospital, Finland, 12 consecutive patients with a head and neck cancer without curative treatment possibilities were enrolled into the study. Five patients had pharyngeal carcinomas, one had an unknown primary tumour growing through the skin on the neck, two had a recurrent malignant melanoma originating from the maxillary sinuses, one had a carcinoma of the tongue, two had laryngeal carcinomas, and one had a recurrent adenoid cystic carcinoma of the parotid gland. RFITT was performed with a CelonLabPrecision® generator using appropriate electrodes. The treatment was administered under local or general anaesthesia. The subjective morbidity of the treatment was evaluated. The response to the treatment was assessed clinically and with radiological imaging when feasible. All but two of the patients received palliation to their disease. RFITT induced clinically a partial response in ten patients, and there were radiological detectable changes. There were no treatment related complications, and the patients tolerated the treatment well. RFITT in head and neck cancer patients is easy to perform, well tolerated, and induces reduction in the tumour mass. Continuous evaluation of RFITT treatment modality is warranted in selected palliative care patients. [ABSTRACT FROM AUTHOR]

The survival figures for advanced stage oropharyngeal carcinoma (OPC) have remained moderate in spite of radical combined modality treatments. The purpose of this study was to investigate the used treatment approach and the outcome of OPC in a nationwide study. Retrospective clinicopathological data of all patients diagnosed with OPC between 1995 and 1999 at the five university hospitals in Finland were reviewed. All patients had a minimum 4-year follow-up. A total of 168 patients (145 men and 23 women, mean age 59 years; range 28 – 89 years) were included. The T categories were as follows: T1, n =34; T2, n =55; T3, n =40; T4, n =39. One hundred and seventeen (69.6%) patients presented with neck node metastases and three (1.8%) patients with distant metastases. In the majority (61.3%) of the patients the tumor was located in the lateral wall of the oropharynx. In 144 (85.7%) patients the treatment was performed with curative intent. Of these, surgery of the primary tumor was performed in 123 (85.4%) patients, and the defect was reconstructed with a pedicled flap or free tissue transfer in 66 (53.7%) of these patients. A neck dissection (ND) was performed in 86 (69.9%) out of these 123 cases. Surgery was the only treatment modality in 10 (6.9%) patients. Radiation therapy (RT) only (with or without chemotherapy) was given to 21 (14.6%), combined treatment with surgery + radiation therapy (S + RT) to 110 (76.4%) and surgery + chemoradiotherapy (S + CRT) to 3 (2.1%) patients. Overall (OS) 3- and 5-year survival rates were 58 and 45%, respectively. Disease-specific (DSS) 5-year survival rates by T-class for the patients treated with curative intent were as follows: T1, 77%; T2, 70%; T3, 66%; T4, 53%. The variable treatment approach, the frequent locoregional recurrences and the moderate survival point out the need to consider new strategies in the management of OPC. [ABSTRACT FROM AUTHOR]

This is the first report on the measurement of nitric oxide (NO) concentrations in the gas phase in a squamous cell culture. The technique may permit the assessment of NO output under conditions that aim to mimic facets of pathology in relatively inaccessible tissues. The primary aim of this study was to devise a method to detect the NO concentration produced by cell cultures in the gas phase of a culture flask. A secondary aim was to determine whether the effect of hypoxia or radiation on NO production in a human squamous cell carcinoma cell culture would be detectable with this technique. The NO concentration was measured off-line using a rapid-response chemiluminescent analyzer. The gas samples were aspirated from cell culture flasks (i) under normal culture conditions, (ii) under conditions of hypoxia and (iii) following radiation of human head and neck squamous cell carcinoma cell line cultures. Elevated levels of the gas phase NO concentration were consistently obtained from the cell culture flasks using this experimental set-up. Hypoxia and radiation diminished NO production. [ABSTRACT FROM AUTHOR]

From a study of nitric oxide (NO) output in the nose and sinuses it seems that: (i) the results obtained regarding the regulation of NO output in the nose do not necessarily apply to the sinuses; (ii) the results obtained for one group of sinuses may not apply to another; and (iii) NO output in the sinuses does not behave as one would expect if it serves to protect against infection. A pilot study was undertaken in one subject to determine whether the control of NO output in the nose differs from that in the sinuses. NO output was measured by aspirating different gaseous concentrations of oxygen (and/or carbon dioxide) through the nasal airways or punctured maxillary and frontal sinuses before and after i.v. administration of L-arginine (20 mg/kg). In the absence of gaseous oxygen in the nose or maxillary antrum, the effect of L-arginine on NO output was the same as that in the presence of oxygen. In the frontal sinus, the effect of L-arginine on NO output was blocked by the absence of gaseous oxygen. NO output in the nose and frontal sinus showed similar changes after either i.v. administration of L-arginine or removal of oxygen from the air. NO output in the maxillary antrum was virtually unaffected by either procedure. NO output in the nose was largely unaffected by the gaseous carbon dioxide content but that in the frontal and maxillary sinuses was profoundly inhibited by it. In both sinuses, suppression of NO output by carbon dioxide was countered by oxygen. Alterations in the oxygen or carbon dioxide content of the maxillary antrum did not alter NO output in the frontal sinus, or vice versa. After i.v. infusion of L-arginine, nasal NO output remained elevated for >1 h. [ABSTRACT FROM AUTHOR]

We describe the speech rehabilitation outcome of patients treated with total laryngectomy or total laryngopharyngectomy and insertion of Provox voice prostheses (Atos Medical AB, Hörby, Sweden) at the Helsinki University Central Hospital. We performed a retrospective chart review of 95 patients (88 men and 7 women; mean age, 63.5 years) who underwent insertion of a voice prosthesis in the period 1992 to 2002. Eighty-one percent (77/95) of the patients underwent a primary prosthesis insertion at the time of laryngectomy. A head and neck surgeon, a laryngologist, and a speech therapist rated the long-term tracheoesophageal speech of 78% (74/95) of the patients as good or average. The main causes for replacement of the device were obstruction, leakage or inadequate size of the prosthesis, and granulation or leakage around the fistula. According to our 10-year experience, use of the Provox prosthesis is an effective method of postlaryngectomy voice rehabilitation, and it continues to be our preferred method of voice restoration in the majority of cases. [ABSTRACT FROM AUTHOR]

It has been shown that inhibition of cyclooxygenasc 2 (COX-2) may cause growth arrest and reduced tumour formation in some human cancers; however, the mechanism is not fully known. In this study, we used an oral squamous cell carcinoma cell line to study growth inhibition and changes in critical cell cycle-regulating proteins induced by the selective COX-2 inhibitor celecoxib. Using cell viability assay, we established the optimal in vitro inhibitory dose of celecoxib and showed that inhibition of COX-2 markedly induces the expression of p27[supkipl], p21, wafl, and the F-box protein skp2. These results add new experimental data to our knowledge of the mechanism of cyclooxygenases on neoplastic cells. [ABSTRACT FROM AUTHOR]

The interaction between noise and inhaled styrene on the structure and function of the auditory organ of the male Wistar rat was studied. The animals were exposed either to 600 ppm, 300 ppm or 100 ppm styrene (12 h/day, 5 days/week, for 4 weeks) alone or in combination with a simultaneous 100–105 dB industrial noise stimulant. Auditory sensitivity was tested by auditory brainstem audiometry at 1.0, 2.0, 4.0 and 8.0 kHz frequencies. Inner ear changes were studied by light microscopy. Exposure to 600 ppm styrene alone caused a 3 dB hearing loss only at the highest test frequency (8 kHz). Quantitative morphological analysis of cochlear hair cells (cytocochleograms) showed a severe outer hair cell (OHC) loss particularly in the third OHC row of the upper basal and lower middle coil. Exposure to noise alone caused only a mild hearing loss (2–9 dB), and only an occasional loss of OHCs (<1% missing). Exposure to the combination of noise and 600 ppm styrene caused a moderate flat hearing loss of 23–27 dB. The cytocochleograms showed a more severe damage of the OHCs than after exposure to 600 ppm styrene alone. The inner hair cells were found to be destroyed in some animals in the upper basal turn only after the combination exposure. Only in combination with noise exposure, the lower styrene concentrations (100 and 300 ppm) induced a hearing loss which was equivalent to that seen after exposure to noise alone. We conclude that: (1) There is an ototoxic interaction between styrene and noise. (2) Synergism is manifested only if styrene is applied in concentrations above the critical level (between 300 and 600 ppm in this study). [Copyright &y& Elsevier]

The diagnosis is the art of determining the nature of a disease, and an accurate diagnosis is the true cornerstone on which rational treatment should be built. Within the workflow in the management of head and neck tumours, there are different types of diagnosis. The purpose of this work is to point out the differences and the aims of the different types of diagnoses and to highlight their importance in the management of patients with head and neck tumours. Qualitative diagnosis is performed by a pathologist and is essential in determining the management and can provide guidance on prognosis. The evolution of immunohistochemistry and molecular biology techniques has made it possible to obtain more precise diagnoses and to identify prognostic markers and precision factors. Quantitative diagnosis is made by the radiologist and consists of identifying a mass lesion and the estimation of the tumour volume and extent using imaging techniques, such as CT, MRI, and PET. The distinction between the two types of diagnosis is clear, as the methodology is different. The accurate establishment of both diagnoses plays an essential role in treatment planning. Getting the right diagnosis is a key aspect of health care, and it provides an explanation of a patient's health problem and informs subsequent decision. Deep learning and radiomics approaches hold promise for improving diagnosis. [ABSTRACT FROM AUTHOR]

To evaluate the genetics of chronic nonsuppurative otitis media (OM). We performed a genome-wide association study of 429,599 individuals included in the FinnGen study using three different case definitions: combined chronic nonsuppurative OM (7034 cases) (included serous and mucous chronic OM), mucous chronic OM (5953 cases), and secretory chronic OM (1689 cases). Individuals without otitis media were used as controls (417,745 controls). We used immunohistochemistry (IHC) of the murine middle ear to evaluate the expression of annexin A13. Four loci were significantly associated (p < 1.7 × 10−8) with nonsuppurative OM. Three out of the four association signals included missense variants in genes that may play a role in otitis media pathobiology. According to our subtype-specific analyses, one novel locus, located near ANXA13, was associated with secretory OM. Three loci (near TNFRSF13B, GAS2L2, and TBX1) were associated with mucous OM. Immunohistochemistry of murine middle ear samples revealed annexin A13 expression at the apical pole of the Eustachian tube epithelium as well as variable intensity of the secretory cells of the glandular structure in proximity to the Eustachian tube. We demonstrated that secretory and mucous OM have distinct and shared genetic associations. The association of GAS2L2 with ciliary epithelium function and the pathogenesis of dysfunctional mucosa in mucous OM is suggested. The abundant expression of annexin A13 in the Eustachian tube epithelium, along with its role in apical transport for the binding and transfer of phospholipids, indicates the role of annexin A13 and phospholipids in Eustachian tube dysfunction. [ABSTRACT FROM AUTHOR]

Background The impact of societal factors on the occurrence of head and neck cancers (HNCs) remains understudied, especially in the Nordic countries. Methods To quantify the association between socio-economic status (SES) and the occurrence of HNCs, this cohort study uses data from the Nordic Occupational Cancer project that combine occupational and cancer registry data from 1961 to 2005 of 14.9 million individuals aged between 30 and 64 years. Occupational categories were combined into seven socio-economic categories. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for the entire national study populations used as reference rates. Results Altogether, 83 997 HNCs—72% in men and 28% in women—were recorded. Among men, a gradient of risk associated with SES was observed for cancers of the tongue, other oral cavity subsites, pharynx, oropharynx and larynx in groups with lower SES. Managers showed decreased SIRs of 0.50 to –0.90 also for cancers of the lip, tongue, other oral cavity subsites, oropharynx, nasopharynx, nose and larynx. In contrast, excess risks of tongue, other oral cavity subsites, pharyngeal, oropharyngeal and laryngeal cancers were observed among clerical (SIRs 1.05–1.16), skilled workers (1.04–1.14), unskilled workers (1.16–1.26) and economically inactive men (1.38–1.87). Among women, no risk gradient similar to that in men was revealed. Conclusions The current study underscores the influence of SES on the incidence of HNCs and highlights the need for targeted interventions, including tobacco and alcohol control policies, and improved access to healthcare services, particularly for socio-economically disadvantaged populations. [ABSTRACT FROM AUTHOR]

Purpose: Sinonasal lymphoma (SL) is a rare lymphatic neoplasm of the nasal cavities, paranasal sinuses and nasopharynx. Whereas some risk factors for SL subtypes have been identified, their aetiology is unknown. Along with other predisposing factors, the viral association of lymphomas, such as Epstein-Barr virus (EBV) and Burkitt and Hodgkin lymphomas, is well-established. Modern molecular biology techniques have enabled the discovery of novel human viruses, exemplified by the protoparvovirus cutavirus (CuV), associated with cutaneous T-cell lymphoma. These findings, and the anatomical location of the sinonasal tract with its rich microbiome and infectious agents, justify in-depth studies among SL. Methods: We analysed the presence of 20 viruses of Orthoherpesviridae, Parvoviridae, and Polyomaviridae by qPCR in 24 SL tumours. We performed RNAscope in situ hybridisation (RISH) to localize the viruses. Parvovirus-specific IgG was analysed by enzyme immunoassay and targeted next-generation sequencing (NGS) was applied to detect CuV in plasma. Results: We detected viral DNA in 15/24 (63%) tumours; nine of EBV, six of human herpesvirus (HHV) -7, four each of HHV-6B and parvovirus B19, two of cytomegalovirus, and one each of CuV and Merkel-cell polyomavirus. We found tumours with up to four viruses per tumour, and localized CuV and EBV DNAs by RISH. Two of the ten plasma samples exhibited CuV IgG, and one plasma sample demonstrated CuV viremia by NGS. Conclusion: Viruses were frequent findings in SL. The EBV detection rate was high in diffuse large B-cell lymphoma, and co-detections with other viruses were prevalent. [ABSTRACT FROM AUTHOR]

A study published in Clinical & Experimental Allergy reveals that asthma is often overlooked and poorly managed in preoperative patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The study, conducted at a tertiary center, aimed to determine the prevalence of asthma and assess its control in this group. The findings indicate a high prevalence of asthma in these patients, with approximately half potentially having undiagnosed or uncontrolled asthma prior to undergoing endoscopic sinus surgery. The study also identifies factors associated with asthma in this population. However, the document acknowledges the study's limitations, such as its small sample size, and suggests the need for further research to validate the results. [Extracted from the article]

Purpose: One of the most common complications after septoplasty is a postoperative infection. We investigated the number of postoperative infections and unplanned postoperative visits (UPV) in septoplasties with and without additional nasal surgery at our institution and evaluated the role of antibiotic prophylaxis. Methods: We collected data of all consecutive 302 septoplasty or septocolumelloplasty patients operated during the year 2018 at the Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital (Helsinki, Finland). Hospital charts were reviewed to record sociodemographic patient characteristics and clinical parameters regarding surgery and follow-up. Results: Altogether 239 patients (79.1%) received pre- and/or postoperative prophylactic antibiotics and within this group 3.3% developed a postoperative infection. The infection rate in the non-prophylaxis group of 63 patients was 12.7% (p = 0.007). When all patients who received postoperative antibiotics were excluded, we found that the infection rate in the preoperative prophylaxis group was 3.8%, as opposed to an infection rate of 12.7% in the non-prophylaxis group (p = 0.013). When evaluating septoplasty with additional sinonasal surgery (n = 115) the rate of postoperative infection was 3.3% in the prophylaxis group and 16.7% in the non-prophylaxis group (p = 0.034). These results show a statistically significant stand-alone effect of preoperative prophylactic antibiotics in preventing postoperative infection in septoplasty, especially regarding additional sinonasal surgery. Conclusion: The use of preoperative antibiotics as a prophylactic measure diminished statistically significantly the rate of infections and UPVs in septoplasty when all postoperative infections, superficial and mild ones included, were taken into account. [ABSTRACT FROM AUTHOR]

Background: The prediction of overall survival in tongue cancer is important for planning of personalized care and patient counselling.Objectives: This study compares the performance of a nomogram with a machine learning model to predict overall survival in tongue cancer. The nomogram and machine learning model were built using a large data set from the Surveillance, Epidemiology, and End Results (SEER) program database. The comparison is necessary to provide the clinicians with a comprehensive, practical, and most accurate assistive system to predict overall survival of this patient population.Methods: The data set used included the records of 7596 tongue cancer patients. The considered machine learning algorithms were logistic regression, support vector machine, Bayes point machine, boosted decision tree, decision forest, and decision jungle. These algorithms were mainly evaluated in terms of the areas under the receiver-operating characteristic (ROC) curve (AUC) and accuracy values. The performance of the algorithm that produced the best result was compared with a nomogram to predict overall survival in tongue cancer patients.Results: The boosted decision-tree algorithm outperformed other algorithms. When compared with a nomogram using external validation data, the boosted decision tree produced an accuracy of 88.7% while the nomogram showed an accuracy of 60.4%. In addition, it was found that age of patient, T stage, radiotherapy, and the surgical resection were the most prominent features with significant influence on the machine learning model's performance to predict overall survival.Conclusion: The machine learning model provides more personalized and reliable prognostic information of tongue cancer than the nomogram. However, the level of transparency offered by the nomogram in estimating patients' outcomes seems more confident and strengthened the principle of shared decision making between the patient and clinician. Therefore, a combination of a nomogram - machine learning (NomoML) predictive model may help to improve care, provides information to patients, and facilitates the clinicians in making tongue cancer management-related decisions. [ABSTRACT FROM AUTHOR]

Knowledge on the role of matrix metalloproteinases (MMPs) in adenoid cystic carcinoma (ACC) is limited. MMPs are capable of degrading almost all extracellular and pericellular components to promote invasion and metastasis. This study aimed to evaluate the immunohistochemical expression of MMP-7, -8, -9, -15, and -25 in ACC and to relate the results with clinicopathological factors and survival. The study included 68 patients with minor salivary gland ACC treated at the Helsinki University Hospital (Helsinki, Finland) in 1974–2012. Samples from 52 patients were available, consisting of 44 primary tumours and eight recurrent tumours. We scored immunostaining of MMP-7, -8, -9, -15, and -25 and analysed the immunoscore against clinical and pathological parameters using statistical correlation test. MMP-9 immunoexpression in pseudocysts of ACC and in peritumoural inflammatory cells associated with better survival and fewer treatment failures. High tumoural MMP-7 and -25 associated with better survival. High tumoural MMP-15 associated with poorer survival and high tumoural MMP-9 with advanced stage and regional recurrences. Tumour cells did not show MMP-8 immunopositivity. These results suggest that MMP-9 may contribute to ACC carcinogenesis in different roles. MMP-7, -8, and -9 can stimulate signalling pathways that may promote tissue modulation and metastatic potential. MMP-15 and -25 may reflect prognosis. [ABSTRACT FROM AUTHOR]

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and neck (H&N) region, presents unique challenges. This study aimed to evaluate the effectiveness of Mohs micrographic surgery (MMS) compared to wide local excision (WLE) in treating H&N DFSP and its impact on recurrence rates and tissue preservation. A comprehensive search was conducted in PubMed/MEDLINE, yielding 29 relevant studies. We included studies comparing MMS and WLE in adult patients with H&N DFSP and reporting local recurrence outcomes. Data were analyzed using random effects analysis, with a meta-analysis performed for comparative studies. Analysis of studies demonstrated a lower recurrence for MMS. Comparative analysis of five studies involving 117 patients showed a significantly lower recurrence rate in the MMS group (2%) compared to the WLE group (19%). Margin status varied between studies, with some achieving negative margins at shorter distances. In the management of H&N DFSP, MMS has emerged as a superior surgical technique, consistently associated with reduced recurrence rates and the potential for tissue preservation. The adoption of MMS should be considered for its capacity to achieve negative margins with fewer processing steps, particularly in anatomically complex regions like the H&N. [ABSTRACT FROM AUTHOR]

Background: Cell-in-cell structures (caused by cell cannibalistic activity) have been related to prognosis of many cancers. This is the first multi-institutional study to assess the prognostic impact of cell-in-cell structures in a large cohort of early oral tongue squamous cell carcinomas (OTSCC).Methods: A total of 308 cases from five Finnish University Hospitals and from the A.C. Camargo Cancer Center, São Paulo, Brazil, were included in this study. Cell-in-cell structures were evaluated on surgical postoperative sections that stained with hematoxylin and eosin staining.Results: We found that cell-in-cell structures associated with cancer-related mortality in univariable analysis with a hazard ratio (HR) of 2.99 (95%CI 1.52-5.88; P = 0.001). This association was confirmed in multivariable analysis (HR 2.22, 95%CI 1.12-4.44; P = 0.024). In addition, statistically significant associations were observed between the cell-in-cell structures and other adverse histopathologic characteristics including deep invasion (P <  0.001), high index of tumor budding (P = 0.007), worst pattern of invasion (P <  0.001), perineural invasion (P = 0.01), and stroma-rich pattern (P = 0.001).Conclusions: Our findings demonstrate a significant relationship between cell-in-cell formation and aggressive characteristics of early OTSCC. Cell-in-cell structures have a distinct impact as a novel prognostic indicator in early OTSCC and they can be easily assessed during routine pathology practice. [ABSTRACT FROM AUTHOR]

Oral squamous cell carcinoma (OSCC) is a common malignancy of the head and neck region. OSCC has a relatively low survival rate and the incidence of the disease is increasing in some geographic areas. Staging and grading of OSCC are established prerequisites for management, as they influence risk stratification and are the first step toward personalized treatment. The current AJCC/UICC TNM staging (8th edition, 2017) of OSCC has included significant modifications through the incorporation of depth of invasion in the T stage and extracapsular spread/extranodal extension in the N stage. Further modifications for AJCC 8 have been suggested. On the other hand, the World Health Organization (WHO) classification (4th edition, 2017) still endorses a simple, differentiation-based histopathologic grading system of OSCC (despite its low prognostic value) and ignores factors such as tumor growth pattern and dissociation, stromal reactions (desmoplasia, local immune response), and tumor-stroma ratio. The various controversies and possible developments of the current staging and grading criteria of OSCC are briefly discussed in this update together with possible applications of artificial intelligence in the context of screening and risk stratification. [ABSTRACT FROM AUTHOR]