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This report presents a rare case of direct invasion from a metastatic submandibular lymph node (SMLN) to submandibular gland (SMG) in a resected specimen of neck dissection (ND) of buccal mucosal squamous cell carcinoma (SCC). The patient was an 82-year-old woman with a clinical diagnosis of the left buccal mucosal SCC (cT4bN2bM0, Stage IVB). The tracheostomy, modified radical neck dissection, buccal mucosal cancer resection including maxillary partial resection, mandibular segmentectomy, and reconstructive surgery with a plate and a free rectus abdominis flap were performed. Pathologically, the infiltrating SCC was observed in the SMG continuous with SMLN metastasis (pT4bN3bM0). No adjuvant therapy was performed for old age and oral intake dysfunction. Contrast CT detected the multiple lung and left scapula metastases at postoperative 5 months, which made the policy of best supportive care. Finally, she died 9 months after the surgery from distant metastases. SMG involvement from direct invasion from a metastatic SMLN is relatively rare. In our case, although the patient died from distant metastases, locoregional control was achieved through curative resection of the primary tumor and ND performed as one block with reconstructive surgery., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Moeka Bukawa et al.)

Background: The submandibular gland (SMG) is sacrificed during neck dissection in patients undergoing curative surgery for oral squamous cell carcinoma (OSCC). This may cause a decrease in the production of saliva and result in xerostomia., Purpose: This study aimed to determine the incidence, invasion patterns, risk factors, and prognosis of SMG involvement in OSCC., Methods: The primary predictor variable in this study was SMG involvement, and the secondary predictor was prognosis., Main Findings: The primary outcome variables were patient characteristics and pathological results for extranodal extension (ENE), perineural invasion (PNI), and pN stage. Four out of 173 patients (2.23 %) showed SMG involvement. Of these cases, one (25 %) was from the primary lesion and three (75 %) were from the metastatic neck lymph nodes (LNs). The primary lesion was located on the lower gingiva, and the other three were from level-Ib LNs with ENE. The pathological PNI was observed in three of the four patients, and ENE was observed in three of the four patients. Preoperative CT and MR revealed SMG invasion and contact in two patients. There were significant differences in the ENE and pN stages between patients with and without SMG involvement (P<0.05). There was a significant difference in the overall survival between patients with (25.0 %) and without (71.5 %) SMG involvement (P = 0.011)., Conclusions: SMG involvement was associated with ENE, pN stage, and poor prognosis., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interest., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Anterior maxillary distraction osteogenesis (AMDO) surgery for cleft lip and palate involves distraction of a segment of the anterior maxilla and advancement using 2 intraoral buccal bone-borne distraction devices. The anterior part of the maxilla is advanced anteriorly with less relapse which increases maxillary length and does not affect speech. We aimed to evaluate the effects of AMDO, including lateral cephalometric changes. Seventeen patients who had undergone this procedure were included in this retrospective study. The distractors were activated by 0.5 mm twice a day after a 3-day latency period. Lateral cephalometric radiographs were evaluated preoperatively, after distraction and removal of distractors, which were compared using the paired Student's t test. Anterior maxillary advancement was obtained in all patients with a median of 8.0 mm. Complications included nasal bleeding and loosening of distractors; however, there was no tooth damage or abnormal movement. The mean sella-nasion-A point (SNA) angle increased significantly, from 74.91° to 79.66°, the A point-nasion-B point angle from -0.38° to 4.34°, and the perpendicular line from nasion to Frankfort Horizontal (NV)-A point from -5.11 to 0.08 mm. The mean anterior nasal spine-posterior nasal spine length increased significantly from 50.74 to 55.10 mm, and the NV-Nose Tip from 23.59 to 26.27 mm. The mean relapse rate of NV-A was 11.1%. AMDO with bone-borne distractor resulted in less relapse and effectively corrected the maxillary retrusion., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)