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Surgical treatment of OSA has emerged as an effective alternative in continuos positive airway pressure (CPAP)-non-compliant group of patients. The present study examines the outcomes following a combination of barbed palatopharyngoplasty (BPP) and endoscopic coblator-assisted midline partial glossectomy in patients with multilevel obstruction of palate, oropharyngeal walls, and tongue base. A retrospective study of 40 patients with predominant obstruction at the velum, oropharyngeal lateral walls, and base of tongue levels, who underwent Barbed Palato Pharyngoplasty and Endoscopic coblator-assisted tongue base resection. Preoperative and post-operative Epworth Sleepiness Score (ESS), and Visual Analog Score (VAS) for snoring. Apnoea-Hypopnoea Index (AHI) and lowest oxygen saturation(L-Sat) were assessed by polysomnography. Improvement in qualityof life parameters were also evaluated. According to the AHI score, 55% of patients had severe OSA, while 45% of patients had moderate OSA. Sleep parameters like AHI, lowest oxygen saturation, and VAS score for snoring significantly improved after surgery (<0.0001). The overall success rate was 62.5%, according to Sher criteria. Following surgery, quality of life improvement in patient centered parameters was also observed in this study. Multilevel surgery with barbed palatopharyngoplasty combined with coblator-assisted midlie glossectomy is an effective treatment modality in patients with moderate-tosevere OSAS. The efficacy of combined surgical treatment was evidenced by improvements in PSG results and patient-centered quality of life parameters. [ABSTRACT FROM AUTHOR]

Tongue cancer significantly impacts speech and swallowing functions, necessitating comprehensive rehabilitation post-surgery. This study evaluates the rehabilitation outcomes of Indian patients who underwent tongue cancer surgery, focusing on speech therapy, nutritional support, and psychosocial interventions. A prospective cohort study was conducted from January 2021 to December 2022 at a tertiary care center in India. Fifty-five patients who underwent partial or hemi-glossectomy were enrolled. Baseline data, including demographic information, medical history, and nutritional status, were collected. Follow-up data on speech therapy outcomes, patient motivation, family support, voice quality, and health-related quality of life (HRQoL) were gathered at six months, one year, and two years post-surgery. Statistical analyses were performed using SPSS version 27. The study included 50 patients with a mean age of 52.3 ± 10.5 years, predominantly male (68%). The most common surgeries were partial glossectomies (70%). Significant improvements were observed in articulation clarity (baseline: 80 ± 10%; two years: 75 ± 11%, p = 0.001), phonetic placement (baseline: 4.5 ± 0.8; two years: 4.2 ± 0.8, p = 0.002), and compensatory strategies (baseline: 4.0 ± 1.0; two years: 3.8 ± 1.0, p = 0.004). Nutritional markers improved post-surgery: BMI (baseline: 23.0 ± 3.4; two years: 23.0 ± 3.1, p = 0.045), albumin (baseline: 3.7 ± 0.5; two years: 4.1 ± 0.4, p = 0.032), and haemoglobin (baseline: 13.2 ± 1.2; two years: 13.5 ± 1.1, p = 0.038). Regression analysis identified age (p = 0.012), motivation (p = 0.001), family support (p = 0.003), BMI (p = 0.025), and psychosocial support (p = 0.005) as significant predictors of rehabilitation success. Comprehensive rehabilitation, including tailored speech therapy, nutritional support, and psychosocial interventions, significantly improves outcomes for tongue cancer surgery patients. The findings highlight the importance of a multidisciplinary approach to rehabilitation, emphasizing the roles of motivation, family support, and early-stage cancer diagnosis in successful recovery. [ABSTRACT FROM AUTHOR]

Objective: To elucidate the prognostic implications of mucosal and deep margin distances in oral tongue squamous cell carcinoma (OTSCC), and to assess a different margin cut‐off value in T1‐T2 versus T3‐T4 tumors. Methods: This single‐center retrospective study included 223 patients who received surgery for a primary OTSCC between January 2017 and December 2021. Results: Multivariable analysis showed that deep margin distance ≥3 mm in T1‐T2 tumors and ≥5 mm in T3‐T4 tumors was significantly associated with better RFS and OS. Mucosal and deep margin distances were globally clinically useful for 2‐year RFS prediction of T1‐T2 tumors, for which deep margins seemed to have more clinical utility than mucosal margins. The influence of margin distances on 2‐year RFS seemed greater for T1‐T2 tumors than T3‐T4 tumors. Conclusion: Mucosal and deep margin distances were associated with OS and RFS in OTSCC. Shorter deep margin distances may be aimed for in T1‐T2 versus T3‐T4 tumors. [ABSTRACT FROM AUTHOR]

Background: An easy-to-use tool to objectively measure intraoral anatomy with meaningful clinical correlations may improve care for patients with Beckwith-Wiedemann syndrome (BWS), who commonly have symptomatic macroglossia. Methods: Children aged 2–17 years with BWS were enrolled between 12/2021 and 01/2024. Digital intraoral photographs with a laser ruler were taken, and morphometric measurements were made using ImageJ software. Relationships between morphometrics and outcomes including BWS clinical score, percentage mosaicism, and incidence of tongue reduction surgery were examined using t-tests and multivariate linear models. Results: Pharyngeal morphometric measurements were obtained in 49 patients with BWS. Mouth area, width, and height differed significantly across BWS molecular subtypes. Right-to-left tongue width and mouth width were larger in those with loss of methylation at imprinting control region 2 (IC2 LOM) than other BWS variants. Patients with paternal uniparental isodisomy of chromosome 11p15 (pUPD11) had narrower mouths than others. Those with tongue reduction surgery had more tongue ridging than those without surgery. There were correlations between mouth area and BWS clinical score, tongue width and BWS clinical score, and tongue length and percentage mosaicism. Conclusion: Intraoral morphometric measurements are associated with phenotypic burden in BWS. Tongue morphology varies across the BWS spectrum, with IC2 LOM having wider tongues and mouths, and pUPD11 having narrower mouths. Tongue ridging is more common in those selected for surgery. Intraoral morphometric measurements may be safely obtained at low costs across centers caring for children with BWS or others at risk of upper airway obstruction. [ABSTRACT FROM AUTHOR]

Oral tongue squamous cell cancer (OTSCC) is one of the most prevalent cancers worldwide and incidence increases with age. An alarming increase in the incidence of OTSCC in the younger age group. This study aimed to explore clinical and histopathological characteristics, survival, and other post-surgical outcomes in patients with OTSCC treated with glossectomy through the Department of Otolaryngology-Head & Neck Surgery at the Ministry of National Guard Health Affairs (MNGHA) within our study period. This is a retrospective study carried out through the collection and analysis of data from medical charts of 56 patients with oral tongue cancer who were treated by glossectomy. Treatment was initiated from January 2010 to December 2021. Patient characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were collected and analyzed. At diagnosis, 62.5% were tobacco smokers, 46.8% had poor dental hygiene, and 76.8% had ulcerative lesions. Furthermore, 33 cases presented with early-stage clinical disease and 23 cases with advanced stage. The median follow-up was 54 months, 28 patients (50%) were free for 3–5 years. Patients who were free on 5-year follow-up had a significantly higher percentage of negative lymphovascular and perineural invasion (p < 0.05). Additionally, 12 patients (21.4%) had developed recurrence. Mortality in all cases was 30.3, but mortality-related cancer was 19.6%. Locoregional failure remains the main cause of treatment failure in resectable OTSCC. Pathological T-stage, N-stage, LVI, PNI, ECE, and LNR are all considered strong prognostic factors. [ABSTRACT FROM AUTHOR]

Abstract Background An easy-to-use tool to objectively measure intraoral anatomy with meaningful clinical correlations may improve care for patients with Beckwith-Wiedemann syndrome (BWS), who commonly have symptomatic macroglossia. Methods Children aged 2–17 years with BWS were enrolled between 12/2021 and 01/2024. Digital intraoral photographs with a laser ruler were taken, and morphometric measurements were made using ImageJ software. Relationships between morphometrics and outcomes including BWS clinical score, percentage mosaicism, and incidence of tongue reduction surgery were examined using t-tests and multivariate linear models. Results Pharyngeal morphometric measurements were obtained in 49 patients with BWS. Mouth area, width, and height differed significantly across BWS molecular subtypes. Right-to-left tongue width and mouth width were larger in those with loss of methylation at imprinting control region 2 (IC2 LOM) than other BWS variants. Patients with paternal uniparental isodisomy of chromosome 11p15 (pUPD11) had narrower mouths than others. Those with tongue reduction surgery had more tongue ridging than those without surgery. There were correlations between mouth area and BWS clinical score, tongue width and BWS clinical score, and tongue length and percentage mosaicism. Conclusion Intraoral morphometric measurements are associated with phenotypic burden in BWS. Tongue morphology varies across the BWS spectrum, with IC2 LOM having wider tongues and mouths, and pUPD11 having narrower mouths. Tongue ridging is more common in those selected for surgery. Intraoral morphometric measurements may be safely obtained at low costs across centers caring for children with BWS or others at risk of upper airway obstruction.

The purpose of the study was to compare the effectiveness of correction of sound pronunciation in patients after glossectomy without reconstructive surgery and glossectomy with reconstructive surgery. Material and Methods. The study included 56 patients with histologically verified stage III –IV oral cavity and oropharyngeal cancer. All patients were divided into two groups: those undergoing reconstructive surgery after glossectomy and those not undergoing reconstructive surgery after glossectomy. Data on the dynamics of sound pronunciation correction were assessed during the rehabilitation period, as well as 6 and 12 months after completion of speech therapy. The parameters were scored from 0 to 4, where 0 indicated no speech sound disorders, and 4 indicated maximum disorders. Results. All patients showed absolute (4 points) speech sound disorders after surgery. Speech rehabilitation in patients, who underwent reconstructive surgery after glossectomy, resulted in a significant improvement in the pronunciation of posterior lingual sounds: [K], [G], [K’], [G’], whistling (lingual-dental) sounds: [S], [S’], [Z ], [Z’], front-lingual sounds: [T], [Т’], [D], [D’] and hissing sounds: [Sh, [Zh] (p

This case report describes, for the first time, a simultaneous occurrence of open-cervix pyometra and gangrene of the tongue in a ten-year-old intact female Griffon dog. The bitch had a three-week history of grayish black thin purulent vulvar discharge, severe licking of the external genitalia, polyuria, polydipsia, inappetence and lethargy. The owner acknowledged of estrous cycle since two months. Blood work revealed severe leukocytosis, neutrophilia, monocytosis and elevated level of globulins. Urinalysis revealed low specific gravity of the urine. Abdominal radiography showed fluid-filled and slightly enlarged uterus. Ultrasonography of the abdomen revealed enlarged uterus with a thickened uterine wall. The diameter, wall thickness, and luminal thickness of the uterus were 2.32 cm, 0.38 cm, and 1.94 cm, respectively. Accumulation of anechoic-hypoechoic pus inside the uterus was also noticed. The case was confirmed as open-cervix pyometra therefore, ovariohysterectomy was carried out. After 48 hours post-operative, the bitch developed dry gangrene of the tongue. The cranial fourth of tongue became cold, insensitive, dry and grayish white. Moreover, there were diminished lingual function and a clear line of demarcation between the healthy and gangrenous parts of the tongue. Partial glossectomy was carried out and tolerated by the bitch. The animal had acceptable and functional outcomes. In conclusion, transmission of infection from open-cervix pyometra to the tongue is possible leading to dry gangrene in dogs.

Squamous cell carcinomas (SCC) account for over 90% of oral cancers. Over the last few decades, there has been a significant increase in the number of cases. Metastasis of oral cancer to the thyroid is extremely rare. Rarer still are tumours metastasizing from the tongue to the thyroid. We present a case of a patient who presented to her dentist with a tongue SCC. Despite radical curative treatment, the tumour metastasized to the thyroid and the patient succumbed to the metastatic disease. We, additionally, highlight the importance of thorough lymph node and neck examination in the dental setting to help identify pathology in patients. CPD/Clinical Relevance: The importance of a thorough lymph node and neck examination at routine dental check-ups is highlighted. [ABSTRACT FROM AUTHOR]

This case report describes, for the first time, a simultaneous occurrence of opencervix pyometra and gangrene of the tongue in a ten-year-old intact female Griffon dog. The bitch had a three-week history of grayish black thin purulent vulvar discharge, severe licking of the external genitalia, polyuria, polydipsia, inappetence and lethargy. The owner acknowledged of estrous cycle since two months. Blood work revealed severe leukocytosis, neutrophilia, monocytosis and elevated level of globulins. Urinalysis revealed low specific gravity of the urine. Abdominal radiography showed fluid-filled and slightly enlarged uterus. Ultrasonography of the abdomen revealed enlarged uterus with a thickened uterine wall. The diameter, wall thickness, and luminal thickness of the uterus were 2.32 cm, 0.38 cm, and 1.94 cm, respectively. Accumulation of anechoic-hypoechoic pus inside the uterus was also noticed. The case was confirmed as open-cervix pyometra therefore, ovariohysterectomy was carried out. After 48 hours post-operative, the bitch developed dry gangrene of the tongue. The cranial fourth of tongue became cold, insensitive, dry and grayish white. Moreover, there were diminished lingual function and a clear line of demarcation between the healthy and gangrenous parts of the tongue. Partial glossectomy was carried out and tolerated by the bitch. The animal had acceptable and functional outcomes. In conclusion, transmission of infection from open-cervix pyometra to the tongue is possible, leading to dry gangrene in dogs. [ABSTRACT FROM AUTHOR]

Background: To address the rehabilitative barriers to frequency and precision of care, we conducted a pilot study of a biofeedback electropalatography (EPG) device paired with telemedicine for patients who underwent primary surgery +/− adjuvant radiation for oral cavity carcinoma. We hypothesized that lingual optimization followed by telemedicine‐enabled biofeedback electropalatography rehabilitation (TEBER) would further improve speech and swallowing outcomes after "standard‐of‐care" SOC rehabilitation. Method: Pilot prospective 8‐week (TEBER) program following 8 weeks of (SOC) rehabilitation. Results: Twenty‐seven patients were included and 11 completed the protocol. When examining the benefit of TEBER independent of standard of care, "range‐of‐liquids" improved by +0.36 [95% CI, 0.02–0.70, p = 0.05] and "range‐of‐solids" improved by +0.73 [95% CI, 0.12–1.34, p = 0.03]. There was a positive trend toward better oral cavity obliteration; residual volume decreased by −1.2 [95% CI, −2.45 to 0.053, p = 0.06], and "nutritional‐mode" increased by +0.55 [95% CI, −0.15 to 1.24, p = 0.08]. Conclusion: This pilot suggests that TEBER bolsters oral rehabilitation after 8 weeks of SOC lingual range of motion. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Tongue reconstruction results following partial glossectomy using primary closure and local tissue rearrangement were evaluated in this study. METHODS: 7 patients diagnosed with tongue carcinoma were included. Tongue defects were reconstructed using local transposition, advancement and rotation of the remaining tongue tissue and closure of the defect. The patients were evaluated 6 months and 1 year following the surgery. RESULTS: None of the patients had permanent speech impairments or major swallowing problems following the surgery despite 33% to 50% reduction in tongue length. CONCLUSION: Unnecessary utilization of microvascular flaps for partial tongue reconstruction should be avoided in partial glossectomy patients in which reduction in tongue length is below 50%. [ABSTRACT FROM AUTHOR]

Background and Aims: Adenoid cystic carcinoma is a rare and slowly progressing cancer that frequently starts in minor salivary glands, often causing no symptoms. Therefore, advanced stage at initial presentation is frequently reported. Case Presentation: We provide a case study of a 33-year-old young woman with pT1 staging adenoid cystic tumour, emphasising the clinical presentation, treatment plan and patient prognosis. Comprehensive examination and imaging tests showed that the patient had a growing mass at the base of her mobile tongue. The diagnosis was supported by histopathological examination. Based on the tumour's small size and minimal invasion, pT1 was assigned as its staging. A comprehensive treatment strategy was used, and during surgery, the tumour was removed with precise margins that preserved both function and appearance. One-year follow-up showed no evidence of recurrence or ongoing problems. Conclusion: This case report emphasises the significance of early diagnosis, thorough treatment planning and attentive follow-up. It also highlights the infrequent presentation of disease. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have demonstrated that obesity may impact the efficacy of anti‐PD1 therapy, but the underlying mechanism remains unclear. In this study, our objective was to determine the prognostic value of obesity in patients with oral tongue squamous cell carcinoma (OTSCC) treated with pembrolizumab and establish a subtype based on fatty acid metabolism‐related genes (FAMRGs) for immunotherapy. Materials and Methods: We enrolled a total of 56 patients with OTSCC who underwent neoadjuvant anti‐PD1 therapy. Univariate and multivariate Cox regression analyses, Kaplan–Meier survival analysis, and immunohistochemistry staining were performed. Additionally, we acquired the gene expression profiles of pan‐cancer samples and conducted GSEA and KEGG pathway analysis. Moreover, data from TCGA, MSigDB, UALCAN, GEPIA and TIMER were utilized to construct the FAMRGs subtype. Results: Our findings indicate that high Body Mass Index (BMI) was significantly associated with improved PFS (HR = 0.015; 95% CI, 0.001 to 0.477; p = 0.015), potentially attributed to increased infiltration of PD1 + T cells. A total of 91 differentially expressed FAMRGs were identified between the response and non‐response groups in pan‐cancer patients treated with immunotherapy. Of these, 6 hub FAMRGs (ACSL5, PLA2G2D, PROCA1, IL4I1, UBE2L6 and PSME1) were found to affect PD‐1 expression and T cell infiltration in HNSCC, which may impact the efficacy of anti‐PD1 therapy. Conclusion: This study demonstrates that obesity serves as a robust prognostic predictor for patients with OTSCC undergoing neoadjuvant anti‐PD1 therapy. Furthermore, the expression of 6 hub FAMRGs (ACSL5, PLA2G2D, PROCA1, IL4I1, UBE2L6 and PSME1) plays a pivotal role in the context of anti‐PD1 therapy and deserves further investigation. [ABSTRACT FROM AUTHOR]

The volume of the reconstructed tongue is considered a critical factor for tongue function. Studies investigating the difference in volume loss between the anterolateral thigh free flap (ALTF) and radial forearm free flap (RFFF) used in reconstruction of the tongue after hemiglossectomy are lacking. The aim of this study was to determine whether there is a significant difference in shrinkage between these two flaps. This was a retrospective study of all patients treated for tongue cancer by hemiglossectomy who underwent either ALTF or RFFF reconstruction at the University of Florida College of Medicine between January 2018 and April 2022. Computed tomography scans were used to measure the volumetric changes in the ALTF and RFFF at two time points over a 6-month period. Of the 85 patients assessed, 10 fulfilled the inclusion criteria: five were reconstructed with an ALTF and five with a RFFF. All underwent adjuvant radiotherapy. The mean ALTF percentage shrinkage was 39.6% ± 3.9%, while for the RFFF it was 51.1% ± 6.2% (P = 0.008). Therefore, it is recommended that the difference in volume loss between the two flaps is taken into consideration. It is suggested that in hemiglossectomy cases, the ALTF is made 1.4 times larger than the defect, while the RFFF is made 1.5 times larger. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma (SCC) is the type of cancer that most frequently affects the oral cavity, mainly in men older than 50 years of age. Treatment for oral SCC often involves surgical excision of the affected margins, resulting in mutilation that affects the patient's quality of life. The objective of this case report is to describe the prosthetic treatment of a 56-year-old man who underwent total glossectomy, resulting in speech and swallowing difficulties. The proposed treatment was a tongue prosthesis retained by orthodontic clasps on the mandibular first molars. After maxillary and mandibular complete-arch impressions were performed and casts were prepared for prosthetic planning, an acrylic resin plate and 3 tongue prototypes were fabricated. Esthetic chemoand functional tests were carried out, and 2 tongue models (1 for speech and 1 for eating) were selected for acrylization, finishing, and polishing. After placement of the prostheses, the patient was referred for follow-up with a speech therapist to improve his adaptation with the prostheses. The patient was satisfied with the prostheses and able to perform the functions of chewing, swallowing, and speech production, which helped in his social reintegration and improved his quality of life. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the postoperative course and long-term functional and aesthetic outcomes in patients with Beckwith-Wiedemann syndrome (BWS) following surgical reduction of macroglossia, using multiple questionnaires. Patients with BWS who underwent keyhole reduction for macroglossia were included in this study. The postoperative course for each patient was recorded, and multiple questionnaires were administered to evaluate aesthetic concerns, oral incompetence or feeding difficulties, sleep-disordered breathing symptoms, and speech. Nine patients underwent ten reduction glossoplasty surgeries. The mean age at surgery was 22 months. The postoperative course for each case was uneventful, except for one patient who had wound dehiscence. The questionnaires revealed significant improvements in tongue appearance, feeding, drooling, facial appearance, and psychosocial outcomes. There was also a significant reduction in sleep-disordered breathing symptoms after surgery. Keyhole reduction glossoplasty is a safe and effective procedure for the treatment of macroglossia in BWS patients, with excellent functional and aesthetic outcomes and a low complication rate. [ABSTRACT FROM AUTHOR]

This article presents a case study of a 51-year-old Caucasian male with advanced oral cavity cancer who underwent neoadjuvant chemotherapy followed by surgery and radiation therapy. The treatment was successful, resulting in tumor regression and improved pain and eating. The article also discusses the importance of surgical factors and the conflicting results regarding the impact of neoadjuvant therapy on outcomes. Perspectives from plastic surgery, pathology, radiation oncology, speech pathology, and a patient's experience are provided. The document concludes by discussing future directions, including the potential use of immunotherapy. [Extracted from the article]

Objective: This study explores the feasibility of ex-vivo high-field magnetic resonance (MR) imaging to create digital a three-dimensional (3D) representations of tongue cancer specimens, referred to as the "MR-based digital specimen" (MR-DS). The aim was to create a method to assist surgeons in identifying and localizing inadequate resection margins during surgery, a critical factor in achieving locoregional control. Methods: Fresh resection specimens of nine tongue cancer patients were imaged in a 7 Tesla small-bore MR, using a high-resolution multislice and 3D T2-weighted Turbo Spin Echo. Two independent radiologists (R1 and R2) outlined the tumor and mucosa on the MR-images whereafter the outlines were configured to an MR-DS. A color map was projected on the MR-DS, mapping the inadequate margins according to R1 and R2. We compared the hematoxylin-eosin-based digital specimen (HE-DS), which is a histopathological 3D representation derived from HE stained sections, with its corresponding MRimages. In line with conventional histopathological assessment, all digital specimens were divided into five anatomical regions (anterior, posterior, craniomedial, caudolateral and deep central). Over- and underestimation 95thpercentile Hausdorff-distances were calculated between the radiologist- and histopathologist-determined tumor outlines. The MR-DS' diagnostic accuracy for inadequate margin detection (i.e. sensitivity and specificity) was determined in two ways: with conventional histopathology and HE-DS as reference. Results: Using conventional histopathology as a reference, R1 achieved 77% sensitivity and 50% specificity, while R2 achieved 65% sensitivity and 57% specificity. When referencing to the HE-DS, R1 achieved 94% sensitivity and 61% specificity, while R2 achieved 88% sensitivity and 71% specificity. Range of over- and underestimation 95HD was 0.9 mm - 11.8 mm and 0.0 mm - 5.3 mm, respectively. Conclusion: This proof of concept for volumetric assessment of resection margins using MR-DSs, demonstrates promising potential for further development. Overall, sensitivity is higher than specificity for inadequate margin detection, because of the radiologist's tendency to overestimate tumor size. [ABSTRACT FROM AUTHOR]

Objective: This review was conducted to define the natural history of unoperated Beckwith-Wiedemann syndrome (BWS) macroglossia and the effect of tongue reduction surgery upon breathing, eating, speaking and dentoskeletal development in individuals having BWS. Design: This is a retrospective study of medical records. Setting: All patients were evaluated and treated in one of two Children's Hospitals by an ACPA approved Craniofacial Team. Patients/Participants: Medical records were reviewed of 526 individuals having a diagnosis of BWS and evaluated in-person by a single craniofacial surgeon between 1986 and 2014 in conjunction with a series of multi-disciplinary craniofacial team colleagues. 28 individuals were excluded having had multiple tongue reductions elsewhere. 498 individuals comprise the "pre tongue-reduction group". The "post tongue-reduction group" consists of 391 individuals who underwent surgical tongue reduction by one surgeon using one technique between 1986 and 2014. Main Outcome Measures: The primary outcome measure was change in anterior dental occlusion following tongue reduction surgery. Tongue reduction surgery was performed on the assumption that it would improve dentoskeletal relationships. Secondary outcome measures were: breathing, feeding/swallowing, and speech. Results: A significant difference (p<0.001) over time between the two groups was found with less anterior occlusal abnormality in the tongue reduction group. Tongue reduction surgery had no mortality and minimal morbidity for breathing, feeding/swallowing, and speech and can ameliorate obstructive sleep apnea. Conclusions: Surgical tongue reduction for BWS macroglossia is recommended for the infant or child in primary dentition with a grossly abnormal anterior tooth/jaw relationship and/or obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

Soft tissue reconstruction of oral cavity defects, such as glossectomy defects secondary to malignancy, pose a challenge for head and neck, oral, and maxillofacial surgeons. Reconstruction options for mucosal defects include primary closure, healing by secondary intention, full mucosal and split-thickness skin grafts, pedicled flaps, and microvascular free flaps. Biological grafts have become an integral part of the modern reconstructive ladder and are widely used for the regeneration of various soft tissue defects, including oral defects. This case series describes our initial experience using ovine forestomach matrix grafts in tongue and oral cavity reconstruction. Oral reconstruction using ovine forestomach matrix grafts was undertaken on three patients post wide excision and resulted in good functional and cosmetic outcomes. The rate of tissue formation provided by the graft and the grafts’ relative resistance to the hostile environment of the oral cavity support further clinical research to validate the use of these devices in oral reconstruction.

Objective: To identify factors influencing volume change in non-osseous oral free flap reconstruction using postoperative cross-sectional imaging and 3-dimensional segmentation of the free flap's muscular and adipose tissue content. Methods: Oral tongue free flap reconstruction cases (2014-2019) were reviewed with inclusion of patients with 3 postoperative, cross-sectional imaging studies with 1 within 6 months, 1 within 1 year, and 1 that spanned 2 years post-reconstruction. Exclusion criteria included recurrence, significant dental artifact, bony reconstruction, and flap failure. Demographics, risk factors, and surgical/clinical treatments were identified. Flap volumes were measured using Materialise MIMICS. Results: Twenty-two patients met strict inclusion criteria. Four flaps were anterolateral thighs and 18 radial forearms. Median percent volume loss greater than 2 years post-reconstruction was 53.2% overall, 58.1% for radial forearms, and 45.4% for ALTs (21.4% for adipose tissue and 57.4% for muscular tissue). Univariate analysis revealed glossectomy amount was associated with percent volume loss (P =.0417). Each successive postoperative month, the flap decreased by 1.54% (P <.0001). Checking for the interaction effect, the percent of flap loss across time was different for glossectomy amount (P =.0093), obesity status (P =.0431), and base of tongue involvement (P =.0472). Conclusion: Glossectomy type, and thus flap size, is a positive predictor for flap atrophy. Obesity and base of tongue involvement are negative predictors for flap atrophy. The amount of tissue loss may differ from classical teachings with median atrophy 53.2% greater than 2 years post-reconstruction. [ABSTRACT FROM AUTHOR]

Oral SCC (OSCC) is the eighth most prevalent cancer in the world. [1] Head and neck cancer account for more than 650,000 cases and 330,000 deaths annually worldwide. India is the world capital accounting for one-third of the global burden.[2] About 60–80% of the patients in India suffering from oral cancer are detected in the advanced stages with tongue malignancies invariably involving floor of mouth (FOM) either by primarily or forming the base of resection.[3,4] Advanced oral cavity lesions, particularly that of tongue and FOM are associated with morbidities like speech, swallowing and breathing difficulty.[5] Hence, a balance between adequate oncological margins and optimal functional outcome is a challenge. Mandibular lip-split and the pull-through are the two commonly used surgical techniques.[6-8] High recurrence rates of 30% with lip-split approach has led us to opt for a more secure radical approach.[9] Para-hyoid region zone is the most common site of early recurrence which is neither included in the dissection specimen nor accessible by trans-oral approach.[10] Therefore, the pull-through technique was devised for en-bloc resection of tongue cancers with cervical lymphatics. We aim to assess the oncological and functional of this Pull-through technique in locally advanced Tongue and FOM cancers. A retrospective observational study was done for patients operated in the institute from Jan 2021 - Jan 2023. 75 patients with locally advanced carcinoma tongue or FOM undergoing resection by pull through approach were included in the study. Surgical Technique (Image1: attachment) In this technique, the Visor approach was used and Subplatysmal skin flaps raised. Bilateral level IA/IB dissection was performed, and the suprahyoid muscles divided from their bony attachment to enter the oral cavity. Subsequently, the gingivo-labial sulcus was incised on either side carefully considering for the margins and the tongue was dropped into the neck, thereby providing access to all parts of the tongue and oropharynx. Mandibulectomy, if required, was done beforehand intraorally delivering the segment with the specimen in toto. Resection and reconstruction was then performed under direct vision. Reconstruction was done either with pedicled or free flap insertion. Reattachment of the digastric muscles or remnant genioglossus, and geniohyoid muscles on both sides with the flap was done to reconstruct the floor. [Display omitted] Post-operative Follow-Up Patients were followed up postoperatively and received adjuvant treatment as per NCCN guidelines and were provided with rehabilitatory support. Six months after the treatment, Speech, swallowing, and breathing was assessed using HNC FIT (Functional Integrity) scales.[11,12] Patient Characteristics A total of 75 patients were included in the study with 55 (73.33%) males and 20 (26.66%) females with a mean age of 47 years (range 30–76 years). Procedural parameters Out of a total of 75 patients, 3(4%) underwent total glossectomy, 11(14.66%) near total and 18(24%) anterior oblique glossectomy. 18 of the 75 patients underwent mandibular resections (6 - segmental and 12- marginal). Histopathology 19 patients had T2 lesions, 26 T3 lesions and 30 T4 primaries. 31 patients (41.3%) had node negative disease while 44 (58.6%) were node positive with 16 having positive contralateral neck nodes. 24 of 75 patients (32%) had lympho-vascular invasion while 37 (48%) had perineural invasion. Functional outcome As an institutional protocol, all patients undergoing major tongue resections were tracheostomised. The median duration of tracheostomy removal was 15th postop day (1st Follow-up) and 57(76%) patients were tracheostomy free by the completion of adjuvant treatment. However, 6(8%) patients had permanent tracheostomies. Ryle's tube feeding was started postoperatively escalating to oral feeds by POD5. Swallowing and speech rehabilitation was provided and on 6 monthly follow up, 17 of 75 (22.5%) patients tolerated solid food (HNCFIT food intake grade 3), 19 (25.3%) soft and 21 (28%) liquid diet, a total of 40 (53.3%) patients in grade 2. 9 (12%) patients required Ryle's tube due to inadequate oral intake (grade 1), while 8 (10.6%) were entirely dependent on tube feeds (grade 0). Out of 75 patients, 4 (5.3%) had no phonation (HNCFIT grade0), 8(10.5%) unclear speech (Grade1), 14(18.66%) had comprehensible speech with telephoning possible (grade 2), 44 (58.6%) had understandable speech with voice change(grade3), 5(6.66%) had normal voice (grade 4). [Display omitted] The pull-through approach had the advantages of good accessibility and functional outcome and ensures resection with adequate margins. Effective surgical treatment can contribute to the improved quality and length of survival of these patients. [ABSTRACT FROM AUTHOR]

Bilateral vocal cord paralysis is a rare complication of endotracheal intubation, causing serious problems. We report a case of bilateral vocal cord paralysis and airway obstruction in the postoperative period after partial glossectomy. A 61-year-old male patient with diabetes mellitus underwent partial glossectomy under general anesthesia. The anesthesia during surgery was uneventful. After extubation, the patient appeared to have airway obstruction and complained of dyspnea. Flexible fiberoptic laryngoscopy was performed immediately, and the patient was diagnosed with bilateral vocal cord paralysis. Therefore, reintubation was performed. The patient was extubated the following day and discharged with incomplete recovery of vocal cord paralysis. The study findings indicate that inappropriate endotracheal tube location and cuff pressure can cause bilateral vocal cord paralysis. The involvement of head position and tongue traction during glossectomy was suggested in this case. Anesthesiologists should be able to consider and manage bilateral vocal cord paralysis in patients with airway obstruction in the postoperative period. [ABSTRACT FROM AUTHOR]

Subtotal or total glossectomy for advanced tongue cancer has an adverse impact on swallowing. The purpose of this retrospective study was to analyse postoperative swallowing outcomes and to determine the ideal reconstruction method in these patients. The clinical and swallowing data of patients with tongue cancer who underwent subtotal glossectomy at the study institution between 2005 and 2019 were reviewed retrospectively. Data were available for 101 patients. The most common reconstruction method was a free rectus abdominis musculocutaneous flap (69 cases). The postoperative feeding tube dependency rate was 11.1% at discharge and 9.4% at 1 year. During the study period, laryngeal suspension and/or a cricopharyngeal myotomy was performed in 39 patients (38.6%), with 25 of these operations performed after 2017. Patients treated in 2017–2019 were significantly more able to take thin liquid (P < 0.001) and lost less weight (P = 0.015) compared to those treated in 2005–2016. Multivariate analysis of 61 patients who did not undergo laryngeal suspension and/or cricopharyngeal myotomy showed significant feeding tube dependency in those aged 65 years and older (P = 0.004). Thin liquid intake was significantly improved after subtotal glossectomy with laryngeal suspension, which led to better postoperative swallowing and improved quality of life. [ABSTRACT FROM AUTHOR]

Wide defects resulting from subtotal or total glossectomy are commonly reconstructed using a bulk flap to maintain oral and speech functions. The flap, including muscle tissue, diminishes with time. This study aimed to compare the surgical outcomes of deep inferior epigastric artery perforator and rectus abdominis musculocutaneous free flap reconstructions after glossectomy with laryngeal preservation. Medical records of 13 and 26 patients who underwent deep inferior epigastric artery perforator and rectus abdominis musculocutaneous free flap reconstructions, respectively, from 2014 to 2022 at our institution were reviewed. Patients who underwent middle pharynx resection except for the base of the tongue, mandibular bone resection, and sensory reinnervation were excluded. The rectus abdominis musculocutaneous groups showed a higher number of lymph node dissection and shorter operative time than the deep inferior epigastric artery perforator groups. No significant differences in postoperative complications or functional oral intake scale scores at 6 months were observed. Volumetric changes on computed tomography images at 6 and 12 months were significantly lower in the deep inferior epigastric artery perforator group. Cancer recurrence was significantly associated with reduced oral function. Oral function in patients with cancer is influenced by various other factors. However, the deep inferior epigastric artery perforator flap may be suitable for tongue reconstruction because of the minimal postoperative changes in flap volume, easy adjustment of flap thickness, elevation of multiple flaps, and minimal complications at the donor site. [ABSTRACT FROM AUTHOR]

Background: There exists a lacuna in the structured reporting of swallowing dysfunction and quality of life (QoL) outcome following major glossectomy. Methods: Prospective cohort study to assess the swallowing dysfunction and QoL following STG (subtotal glossectomy) or NTG (near total glossectomy) over a 6‐month period using FEES and PAS scale, MDADI, and FACT‐HN. Results: Twenty‐four patients were available for analysis. The pre‐ and post‐adjuvant evaluation revealed a statistically significant improvement in the composite MDADI and FACT‐HN scores. Subscale analysis of FACT‐HN scores revealed maximum deficit in the head and neck cancer‐specific score domain followed by functional domain and social well‐being domain, with serial improvement noted in the post‐adjuvant setting. Conclusion: This study showed serial improvement in terms of swallowing dysfunction although social and functional well‐being domains related to QoL continued to reveal major deficits. Better outcomes were seen with preservation of bilateral base of tongue and mandible. [ABSTRACT FROM AUTHOR]

Introduction: Head and neck squamous cell carcinoma (HNSCC) patients suffer from frequent local recurrences that negatively impact on prognosis. Hence, distinguishing tumor and normal tissue is of clinical importance as it may improve the detection of residual tumor tissue in surgical resection margins and during imaging-based surgery planning. Differences in O2 consumption (OC) can be used to this aim, as they provide options for improved surgical, image-guided approaches. Methods: In the present study, the potential of a fluorescent sensor foil-based technology to quantify OC in HNSCC was evaluated in an in vitro 3D model and in situ in patients. Results: In vitro measurements of OC using hypopharyngeal and esophageal cell lines allowed a specific detection of tumor cell spheroids embedded together with cancer-associated fibroblasts in type I collagen extracellular matrix down to a diameter of 440 pm. Pre-surgery in situ measurements were conducted with a handheld recording device and sensor foils with an oxygen permeable membrane and immobilized O2-reactive fluorescent dyes. Lateral tongue carcinoma and carcinoma of the floor of the mouth were chosen for analysis owing to their facilitated accessibility. OC was evaluated over a time span of 60 seconds and was significantly higher in tumor tissue compared to healthy mucosa in the vicinity of the tumor. Discussion: Hence, OC quantification using fluorescent sensor foil-based technology is a relevant parameter for the differentiation of tumor tissue of the head and neck region and may support surgery planning. [ABSTRACT FROM AUTHOR]

Background: Early-stage tongue cancer has a good prognosis in general; however, high-risk patients with late cervical lymph node and distant metastases have a poor prognosis. Elective neck dissection and postoperative chemoradiotherapy are considered for these patients, although no clear criteria have been identified for their evaluation. Methods: This retrospective observational study aimed to determine the predictive factors for late cervical lymph node and distant metastases in 102 patients with cT1-2N0 tongue cancer. The data regarding the demographic characteristics, as well as the depth of invasion, tumor budding, histological grade, and tumor–stromal ratio, among other things, were extracted from medical records. Results: We found that the potential lymph node metastasis rate was 27.5%. The significant clinical predictors of late cervical lymph node metastasis were the tumor thickness and endophytic growth pattern and the significant histopathological factors were poorly and moderately differentiated tumors and ≥3 tumor buds. In addition, the prognostic factors for distant metastasis included ≥4 lymph node metastases, ≥7 tumor budding, and moderate and poor tumor differentiation. Conclusions: The usefulness of tumor budding as a predictor of metastasis for tongue cancer was suggested. The findings of this study can help establish the criteria for evaluating the metastasis risk and prognosis of patients with tongue cancers. [ABSTRACT FROM AUTHOR]

Introduction: Tongue carcinoma presents a global oncological challenge due to its aggressive nature and late-stage diagnosis. Glossectomy, a key surgical procedure for advanced cases, significantly affects both cancer control and essential functions such as speech and swallowing. Aim: To analyse the impact of different glossectomy types on oncological and functional outcomes in patients with advanced carcinoma of the tongue. Materials and Methods: A cross-sectional study was conducted in the Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Uttarakhand, India over a one-year period from September 1, 2022, to August 31, 2023. The study included 47 patients with squamous cell carcinoma of the oral and posterior tongue who underwent glossectomy. Oncological outcomes (mortality and hospital stay) and functional outcomes (swallowing, speech, dysphagia, and Quality of Life (QoL)) were assessed. The questionnaires used were the EORTC Core Quality of Life questionnaire (EORTC QLQ-C30), EORTC questionnaire for the assessment of QoL in head and neck cancer patients (EORTC QLQ-H&N35), M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI). Follow-up was conducted at the 6th week to assess changes in the functional aspects compared to the baseline scores. Data were entered into Microsoft Excel, and the analysis was performed using Statistical Packages for Social Sciences (SPSS) software version 25.0. The data were analysed using the Wilcoxon Signed Rank test. A p-value of <0.05 was considered statistically significant. Results: The study comprised 37 (78.72%) males and 10 (21.28%) females, with a mean age of 47.77±12.6 years. Preoperative staging indicated that 22 (46.81%) patients had T2N0 stage, 16 (34.04%) patients had T3, and 9 (19.15%) patients had T4a disease. Among the patients, 14 (29.79%) underwent partial glossectomy, 27 (57.45%) underwent hemiglossectomy, and 3 (6.38%) underwent subtotal glossectomy, and 3 (6.38%) underwent total glossectomy. The mean duration of hospital stay was 10.09±2.87 days. There were no instances of mortality or tumour recurrence at the 6th week. Regarding the functional outcomes, compared to baseline, at the 6th week, there was a significant decrease in EORTC QLQ-H&N35 median scores from 6.94 to 1.73 (p=0.005), but no significant change in the mean EORTC QLQ-C30 (90±8.22 versus (vs) 89.72±8.52, p=0.368), mean MDADI (4.51±1.2 vs 4.43±1.19, p=0.585), and mean SHI (15.81±25.76 vs 13.43±26.19, p=0.052). Conclusion: It can be inferred that glossectomy for advanced carcinoma of the tongue leads to a significant improvement in symptoms; however, the overall Quality of Life (QoL) and functions of the tongue such as swallowing and speech remain comparable to pre-surgery levels. [ABSTRACT FROM AUTHOR]

Partial glossectomy is the most common procedure for early-stage tongue cancer. Although late postoperative bleeding occasionally occurs, the associated risk factors have not been adequately identified. We aimed to investigate the rate and risk factors for late postoperative bleeding after transoral partial glossectomy with or without neck dissection for tongue cancer at our institution. We analysed 211 patients who had undergone transoral partial glossectomy between January 2016 and January 2023. The potential risk factors associated with late postoperative bleeding were investigated using univariate and multivariate logistic regression analyses. Of the 211 patients, 40 (19%) showed late postoperative bleeding, with 19 (9%) classified as grade IIIa (Clavien-Dindo classification). Regarding all grades, late postoperative bleeding was significantly higher in patients aged <70 years and in those with polyglycolic acid (PGA) sheets (p =.046 and.030, respectively). For grade ≥ IIIa, late postoperative bleeding was significantly higher in patients with a history of anticoagulant/platelet administration, a mucosal defect covered with fibrin glue and a PGA sheet (p =.045 and.026, respectively). The findings of this study suggest that primary closure decreases the frequency of late postoperative bleeding. [ABSTRACT FROM AUTHOR]

Beckwith-Wiedemann Syndrome (BWS) is a rare genetic disorder that causes developmental defects as well as an elevated risk of malignancies. Macroglossia, or an enlarged tongue, is a common symptom of BWS that may have a negative influence on a person's quality of life. The aim of this systematic review is to look at the present state of knowledge about the repercussions of macroglossia, as well as the influence of the timing of surgical resection, or glossectomy, in the treatment of severe cases of macroglossia (Ref. 35). [ABSTRACT FROM AUTHOR]

Background: The increased life expectancy and accompanying comorbidities of elderly patients is in- creasing the need for composite soft tissue defect reconstruction. Since its introduction in 2004, the superficial circumflex iliac artery perforator (SCIP) flap has become popular among reconstructive surgeons for its various advantages. We describe our experience of free SCIP flap reconstruction in geriatric patients and examine its versatility in a literature review. Methods: Between 2018 and 2022, 19 geriatric patients (12 males, 7 females; 65--82 years old) under- went free SCIP flap transfer for reconstruction. The locations of the defects were all over the body area, from the trunk to the extremities. Patient perioperative demographic data are listed, along with surgical outcomes and complications. Results: In our experience, only one of 19 free SCIP flaps failed (total skin flap necrosis), presenting an overall flap survival rate of 94.7%. Partial flap loss was noted in 2 cases, which could be managed by other minor operations. Over at least 6 months of follow-up, all surviving flaps showed good contour and minimal donor site morbidity. Conclusion: The success rate was high and remained stable over time in geriatric patients managed with free SCIP flap reconstruction. The appearance of recipient and donor sites was optimal. With reduced donor site morbidity, we believe that the free SCIP flap will become a popular option for composite soft tissue defect coverage in the elderly. [ABSTRACT FROM AUTHOR]

Introduction and Objective. Common carotid arteries are paired vessels supplying the head and neck, and in surgical practice their trifurcation can impact the effectiveness of various oncologic, reconstructive, and interventional procedures. Understanding anatomical variations is crucial for avoiding complications and improving procedural safety. The aim of the study was to review the literature and systematize knowledge regarding the anatomy of the common carotid a. trifurcation, with particular emphasis on its role in procedures such as carotid a. stenting, carotid endarterectomy, tumour embolization, glossectomy, thyroidectomy, and lymph node resection. Review Methods. A literature review (including 9 original studies and 11 case reports) was conducted, considering studies on the anatomy of the common carotid a. trifurcation based on cadaveric and radiological material. Various variants of the common carotid a. trifurcation were identified, and their frequency of occurrence documented in the study. Brief description of the state of knowledge. Based on the analyzed literature, the most frequently observed third branch of the division was the superior thyroid a. (20-76.6%). Other isolated cases included the superior laryngeal a., ascending pharyngeal a., occipital a., and lingual a. Conclusions. Analyzing the diversity of the common carotid a. trifurcation reveals its frequent occurrence, suggesting the necessity to consider this variability in head and neck medical procedures. The most common third branch is the superior thyroid a., which holds significant importance for diagnostic and therapeutic strategies in the area of the thyroid gland. While cases of large vessels, such as the vertebral a., departing from the trifurcation are rare, their consideration is crucial in procedural planning. [ABSTRACT FROM AUTHOR]

Background and Aims: The outbreak of the Coronavirus disease 2019 (COVID‐19) pandemic had a significant effect on the diagnosis and treatment of head and neck cancers. Therefore, in this study, we decided to discuss the impact of COVID‐19 on the stage and histological characteristics of patients with tongue cancer from March 2020 to March 2021 and compared to the previous 3 years. Methods: In this time series study, patients diagnosed with squamous cell carcinoma of the operated tongue cancer were divided into two groups. Patients who operated from March 2020 to March 2021 (n = 36) and patients who operated 3 years ago (n = 70) were included in the study. The results were analyzed using SPSS 21 software. Results: The study found that during the pandemic, the stage of tongue cancer in patients who underwent surgery was higher than before the pandemic (p = 0.01). Moreover, the depth of invasion was significantly higher during the COVID‐19 outbreak in the pathology sample of the patients (p = 0.006), while the involvement of lymph nodes and other variables between the groups was not statistically significant. Conclusion: COVID‐19 has adverse effects on the diagnosis and treatment of tongue cancer. Also, it leads to advanced stages of the tumor and increases the depth of invasion of the cancer. Hence, it is important to plan correctly and appropriately for the diagnosis and treatment of these patients in conditions such as the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma of the tongue is an aggressive malignancy which frequently metastasizes to cervical lymph nodes. Up front surgical resection is the mainstay of treatment for oral cavity squamous cell carcinomas. Glossectomies are typically performed under general anesthesia with endotracheal intubation for airway protection, to mitigate pain, and ensure patient tolerability for optimal oncologic outcomes. This is among a few reported cases using local anesthesia for partial glossectomy and sentinel lymph node biopsy to avoid the risks of general anesthesia in a patient with compromised respiratory status. Clinical data was obtained through electronic medical records and a literature search performed. A 63-year-old female presented with cT2N0M0 Squamous Cell Carcinoma of the right lateral tongue. Her relevant past medical history included idiopathic pulmonary fibrosis and pulmonary arterial hypertension with chronic hypoxic respiratory failure. Pulmonology was consulted pre-operatively given the patient's significant pulmonary co-morbidities and determined the patient would have a high risk of perioperative mortality given likelihood of developing post-operative respiratory failure. After discussing risks of general anesthesia with the patient, she opted to undergo the procedure utilizing local anesthesia. The procedure was technically successful, and the patient survived for 18 months following treatment without evidence of disease before succumbing to another disease process. This case report demonstrates the feasibility of utilizing local anesthesia for select early oral cavity cancer patients who are high risk for general anesthesia. [ABSTRACT FROM AUTHOR]

Self-sucking behavior in cows, is a behavioral defect that leads to significant milk loss in dairy farming. This retrospective case series aims to present the surgical experience and long-term outcomes of 200 cows exhibiting self-sucking behavior. The objective of this study is to evaluate the outcomes of four surgical techniques used to treat self-sucking in cows, including wound healing, complications, recurrence, and feeding difficulties. The follow-up period extended up to 2 years postoperatively, with repeated visits by the same surgeon. The study included 200 cows of mixed and native breeds. Four surgical techniques were employed to address self-sucking behavior. The same surgeon monitored the outcomes over time, assessing factors such as wound healing, complications, recurrence rates, and feeding difficulties. Long-term analysis revealed that the more invasive techniques, such as lateral glossectomy and ventral partial glossectomy, demonstrated the highest success rates at 100% and 96% respectively. In contrast, the less invasive techniques, ventral lingual inverting sutures and intralingual sutures, had success rates of 58% and 50% respectively. This study provides valuable insights into the long-term outcomes of various surgical techniques for correcting self-sucking behavior in cattle. The results indicate that lateral partial full thickness glossectomy yielded favorable outcomes with no recurrence and minimal postoperative complications. The findings from this study offer important considerations for decision-making regarding the optimal surgical correction of self-sucking in cattle, assisting veterinarians and farmers in selecting the most effective approach.

Introduction Airway fire is a life-threatening complication in the operation table which is preventable. We report an incident of airway fire that occurred during a tracheostomy and discuss what went wrong. Case report A 48-year-old gentleman with carcinoma tongue and multinodular goiter underwent modified radical neck dissection, hemithyroidectomy, tracheostomy, hemi glossectomy, and free radial forearm flap reconstruction. During tracheal hemostasis with cautery, a flame appeared, and airway burns resulted. It was extinguished in a few seconds with wet mops, but the resultant combustion injury of the tracheobronchial tree and later bilateral pneumonia required multiple sittings of bronchoscopic toileting and intensive airway management for recovery. Discussion This report is to make anesthetists and surgeons aware of such a rare but life-threatening complication, its prevention, and early therapeutic steps which can prevent long-term complications and death.

Introduction: Identification of occult lymph node metastasis is challenging in early tongue cancers. We conducted a prospective study to determine the most characteristics ultrasonic feature suggestive of metastatic node. Material and Methods: A preliminary study based on feasibility was planned on twenty five patients with squamous cell carcinoma of tongue (T1,T2) and N0 neck underwent ultrasonography of neck. The results of each ultrasonic parameters (size, shape, echogenicity, margin and hilum) for suspicion were analysed. Pathologic evaluation of surgical resected neck specimen served as the reference standard. Results: USG yielded sensitivity and specificity by size, by morphology, either size or morphology are 50.0% and 87.5%, 75.0% and 87.5, 75.0 and 83.3% respectively. Morphology alone has highest negative predictive value (NPV:91.3%) with accuracy of 84.3%. Conclusion: Morphology of the lymph node had highest sensitivity and specificity with highest negative predictive value correlating with its metastatic nature. [ABSTRACT FROM AUTHOR]

Generally, systemic chemotherapy is indicated for oral squamous cell carcinoma with distant metastasis and has a poor prognosis. Recently, the advent of molecular targeted drugs, such as cetuximab and immune checkpoint inhibitors, has dramatically improved prognosis, though controlling distant metastasis remains challenging. We report a case of tongue cancer in which lung metastases disappeared in the long term. A 60-year-old Japanese male with squamous cell carcinoma of the tongue underwent preoperative chemoradiotherapy and surgery including subtotal glossectomy, bilateral modified radical neck dissection, and immediate reconstruction with an anterolateral thigh flap. One month after surgery, multiple nodules less than 10 mm in diameter appeared in both lungs on CT imaging. Multiple lung metastases were diagnosed with no local recurrence or regional lymph node metastasis. The patient continues to receive a 4-week treatment course of chemotherapy that included cetuximab every 3 months and the lung metastases were markedly reduced in size or had disappeared. No local recurrence or newly emerged metastases were observed. The patient has been doing well for nine years since the appearance of the lung metastases. [ABSTRACT FROM AUTHOR]

Objective: Ankyloglossia affects a person's overall well-being and life, from malnutrition due to poor feeding and mechanical problems to psychological stress and low self-esteem, thus affecting social life. This case reports the use of non-scalpel techniques, such as a super pulsed laser, to manage ankyloglossia in a non-syndromic patient suffering from speech incompetence and restricted tongue mobility and highlights its advantages over other conventional techniques. Case Report: A 17-year-old male patient presented with a complaint of restricted tongue mobility, due to which he could not pronounce certain words clearly. As the patient was apprehensive about the use of a scalpel, it was decided to manage ankyloglossia using a diode laser against the conventional scalpel technique. Thus, the laser-assisted lingual frenectomy using GaAs super pulsed laser was used to excise the lingual frenulum. Conclusion: This case report suggests that ankyloglossia can be successfully treated by using laser-assisted surgery and gives superior results specifically in terms of lesser pain and bleeding. [ABSTRACT FROM AUTHOR]

Introduction: Palate development involves a genetic regulation through a complex molecular mechanism that may be disrupted by environmental factors, resulting in impaired fusion and cleft palate formation. An encounter with a case of cleft palate due to dorsal tongue hamartoma prompted us to perform this systematic review. Objective: To review the clinical profile and management approach for a case with cleft palate and tongue hamartoma. Design: A systematic literature search was conducted using keywords related to cleft palate and tongue hamartoma in PubMed, Scopus, MEDLINE, and Scielo databases through December 2021, with no time or language restrictions. Patients, Participants: Studies reporting patients with cleft palate and tongue hamartoma were included. Main outcome measure(s): Information related to clinical profile, diagnostic tests, histopathology, management, and outcomes were extracted. Results : Fourteen relevant publications were identified with 16 cases reported so far. Among them, thirteen patients were females (81.25%), and 3 were males (18.75%). The age of presentation varied from birth to 19 years. Oral-facial-digital syndrome (type II) was the most commonly associated syndrome. Conclusion : Congenital tongue hamartoma with cleft palate is a rare presentation, which can present as an isolated entity or part of a syndrome. Genetic evaluation is warranted, particularly for multiple hamartomatous lesions. The preferred treatment is immediate excision of hamartoma while following a standard timeline for palatoplasty. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the effects of operative time and 2 team approach on complications after soft tissue free flap reconstruction for oral tongue cancer. Methods: Patients with oncologic glossectomy with myocutaneous or fasciocutaneous free flap reconstruction were included from the 2015 to 2018 American College of Surgery National Surgical Quality Improvement Program. The primary predictive variables assessed were operative time and 2 team approach; control variables included age, sex, body mass index (BMI), 5-question-modified frailty index (mFI-5), American Society of Anesthesiologists (ASA) class, and total work relative value units (wRVU). Outcomes assessed included 30-day mortality, 30-day reoperation, hospital length of stay beyond 30 days, readmission, medical and surgical complications, and non-home discharge. Multivariable logistic/linear regression models were used to predict surgical outcomes. Results: Microvascular soft tissue free flap reconstruction of the oral cavity after glossectomy was performed on 839 patients. Operative time was independently associated with readmission, prolonged length of stay, surgical complications, medical complications, and non-home discharge. A 2-team approach was independently associated with prolonged length of stay and medical complications. The mean operative time of the 1-team and 2-team approach was 8.73 and 9.13 hours. The 1-team approach did not significantly increase operative time (P =.16). Conclusions: In the largest study to date of operative time on post-surgical outcomes after glossectomy and soft tissue free flap reconstruction, we found longer operative times increased rates of postoperative complications and non-home discharge. The 1-team approach is non-inferior to the 2-team approach with respect to operating time and complications. [ABSTRACT FROM AUTHOR]

Background: A multicentric study was conducted on technical reproducibility of compartmental tongue surgery (CTS) in advanced tongue cancers (OTSCC) and comparison to standard wide margin surgery (SWMS). Methods: We studied 551 patients with OTSCC treated by CTS and 50 by SWMS. Oncological outcomes were analyzed. A propensity score was performed to compare survival endpoints for the two cohorts. Results: In the CTS group, survival and prognosis were significantly associated with positive lymph‐nodes, extranodal extension, depth of invasion and involvement of the soft tissue connecting the tongue primary tumor to neck lymph nodes (T‐N tract), independently from the center performing the surgery. SWMS versus CTS showed a HR Cause‐Specific Survival (CSS) of 3.24 (95% CI: 1.71–6.11; p < 0.001); HR Loco‐Regional Recurrence Free Survival (LRRFS) of 2.54 (95% CI: 1.47–4.40; p < 0.001); HR Overall Survival (OS) of 0.11 (95% CI: 0.01–0.77; p = 0.03). Conclusion: Performing the CTS could provide better CSS and LRRFS than SWMS regardless of the center performing the surgery, in advanced OTSSC. [ABSTRACT FROM AUTHOR]

Background/Aim: The tongue is an important anatomical structure, playing an significant role in natural speech, swallowing, and sense of taste. Immediate reconstruction using autologous tissue must be performed following glossectomy for tongue cancer to improve patient quality of life. This study aimed to demonstrate the usefulness of a surgical technique using the free vertical latissimus dorsi flap (FvLDF) for tongue reconstructions using autologous tissue. Patients and Methods: Among patients who underwent total glossectomy for tongue cancer from November 2014 to February 2023, we selected 10 patients who underwent immediate tongue reconstruction with a radial free forearm flap (RFFF) or free anterolateral thigh flap and four patients who underwent FvLDF. The patients were compared regarding postoperative function (width of oropharyngeal space in computed tomography, language-speech evaluation), aesthetic results, and features. Results: All four patients who underwent FvLDF showed successful flap survival, with no severe complications. Because vertical incision was made during flap harvest with primary closure possible with the mid-axillary line, donor morbidity was significantly lower in patients who underwent reconstruction with FvLDF than in those who underwent reconstruction with RFFF, and good aesthetic results were obtained. In comparing the oropharyngeal space of patients on neck CT preoperatively and postoperatively, the width increase rate of patients who underwent reconstruction with FvLDF was significantly smaller. FvLDF patients demonstrated good speech and swallowing functions. Conclusion: Considering the advantages of reconstruction with FvLDF in terms of features and aesthetic results, this surgical technique may be a reliable alternative technique for tongue defects after glossectomy. [ABSTRACT FROM AUTHOR]

Background: Oral squamous cell carcinoma (oSCC) commonly affects the tongue. Surgical reconstruction contributes to improvements in quality of life. Therefore, we conducted this systematic review to compare the quality of life among patients who underwent glossectomy and then reconstructed with radial-free forearm flap (RFFF) versus anterolateral thigh flap (ALTF) in terms of functional outcome, flap survival, complications, donor site morbidity, and esthetic outcome. Methods: This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The study systematically reviewed MEDLINE, Cochrane, and EMBASE databases without specifying a time frame. Results: As a result of reviewing literature, 95 articles were screened by full-text resulting in 36 articles which met our inclusion/exclusion criteria. However, only 14 articles were included in the quantitative synthesis (meta-analysis). Out of the 36 articles, 24 studies were excluded from the meta-analysis due to the inclusion of one arm (RFFF or ALTF), and 3 articles were excluded due to the lack of the primary outcomes. Conclusions: Our results show evidence of lower donor site morbidity and a better esthetic outcome for ALTF compared to RFFF. Speech and swallowing were both affected following tongue reconstruction. Level of evidence: Not gradable. [ABSTRACT FROM AUTHOR]

Background: Beckwith-Wiedemann syndrome (BWS) is caused by a genetic mutation of chromosome defects at 11p15 S. It is seen in 1 in 10,400 to 13,800 cases, and the association between BWS and congenital heart disease (CHD) is not reported; amniocentesis or chorionic villus sampling is a diagnostic tool. Tongue reduction surgery for macroglossia is the treatment of choice. An early psychological assessment has a beneficial effect on long-term consequences. Case presentation: An 11-month-old female Asian Indian child was referred to the pediatric ward for macroglossia, tachypnea, chest retraction, and not feeding correctly with no history of cyanosis or sign of developmental delay. The patient was born via elective cesarean section at 37 weeks and diagnosed with Beckwith-Wiedemann syndrome by clinical examination. The mother narrated that the patient has frequent fever, cold, and cough episodes after two months of life. An echocardiogram test was done, which showed signs of patent ductus arteriosus (PDA). Devise closure was done. The patient was discharged after 15 days after surgery. On follow-up, the patient was observed for the developmental milestone and advised for ultrasonography (USG) of the abdomen every three months. Discussion: Testing for 11p15, a test in the genetic evaluation, should be done, as it is altered in BWS. Macroglossia was present in our case report. Timing for surgery for macroglossia is before age two years to obtain favorable functional and esthetic results. Among CHD, PDA was commonly seen in BWS; BWS is a cancer predisposition syndrome, and the most common type is Wilms tumor. No tumors were seen in the present case report. Conclusions: The mechanism of association of BWS with PDA is unknown. Patients should be monitored for psychosocial and emotional behavior. Physicians should be aware of this condition so intervention can be done effectively.