A Novel Risk Model for Predicting Dysphagia after Tongue Reconstruction: A Retrospective Multicenter Study in Japan

BACKGROUND

There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, the authors developed a novel risk model for predicting dysphagia after tongue reconstruction.

METHODS

This retrospective study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical, or OPERA, group across 31 cancer centers and university hospitals in Japan. A total of 532 patients [390 (73.3%) men and 142 (26.7%) women; median age at surgery, 60 years (range, 15 to 88 years)] who were diagnosed with oral tongue squamous cell carcinoma and underwent tongue reconstruction following glossectomy between 2009 and 2013 were included. Independent risk factors were identified using univariate regression analysis and converted to a binary format for multivariate analysis. An integer value was assigned to each risk factor to calculate a total score capable of quantifying the risk of feeding tube dependence.

RESULTS

Overall, 54 patients (10.2%) required a feeding tube at the time of evaluation. Predictive factors for feeding tube dependence were advanced age, lower American Society of Anesthesiologists physical status, low body mass index, lower serum albumin, comorbid hypertension and diabetes, extended tongue defect, resection beyond the tongue, laryngeal suspension, postoperative radiation therapy, and no functional teeth. In multivariate logistic regression analysis, age greater than or equal to 58.5 years, postoperative radiation therapy, wider tongue defect, and body mass index less than 21.27 kg/m 2 earned 6, 4, 3, and 2 points, respectively, for a maximum total score of 15.

CONCLUSION

The authors' risk model provides a mathematical tool for estimating the individual risk of postoperative feeding tube dependence before tongue reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, III.

Quality of life in tongue cancer treated patients before and after speech therapy: a randomized clinical trial

Introduction

Tongue cancer is one of the most common subtypes of head and neck cancer. The aggressive effects of treatment cause aesthetic, psychosocial and functional deficits, especially dysphagia, which affects patient quality of life. Rehabilitation, which is essential for functional maximum recovery, helps patients deal with new and altered structures and has a positive impact on quality of life.

Objective

To verify the impact of speech therapy on swallowing quality of life in tongue cancer patients after treatment.

Methods

This parallel randomized clinical trial was conducted at a public hospital in Porto Alegre, RS, Brazil. Before and after the intervention, a quality of life questionnaire (the Deglutition Handicap Index) was employed, dysphagia severity was assessed with fiberoptic endoscopic evaluation of swallowing, and the Functional Oral Intake Scale carried out. The experimental group underwent four-week sessions of speech therapy over one month, while the control group received the institution’s usual follow-up.

Results

Thirty individuals treated for tongue cancer were divided into a study and a control group. Deglutition Handicap Index scores decreased significantly (approximately 40 points) (p < 0.001) after the intervention in the study group. There was a significant correlation between improved quality of life, reduced dysphagia severity and increased in Functional Oral Intake Scale scores (p < 0.001).

Conclusion

After speech therapy, quality of life scores related to deglutition and dysphagia severity improved in patients treated for tongue cancer.

SARS-CoV-2 detection in formalin-fixed paraffin-embedded tissue specimens from surgical resection of tongue squamous cell carcinoma

In the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, pathologists can be exposed to infection handling surgical specimens. Guidelines related to safety procedures in the laboratory have been released. However, there is a lack of studies performed on biopsy and surgical resection specimens. Here we report the detection of SARS-CoV-2 in formalin-fixed paraffin-embedded samples from surgical resection of tongue squamous cell carcinoma of a patient who developed COVID-19 postsurgery. RNA of SARS-CoV-2 strain was detected in the tumour and the normal submandibular gland samples using real-time PCR-based assay. No viral RNA was found in metastatic and reactive lymph nodes. We demonstrated that SARS-CoV-2 RNA can be detected in routine histopathological samples even before COVID-19 disease development. These findings may give important information on the possible sites of infection or virus reservoir, and highlight the necessity of proper handling and fixation before sample processing.

Fu's subcutaneous needling for subcutaneous adhesions and scar hyperplasia in the neck region: A case report

RATIONALE

Lymphadenectomy for tongue cancer in the neck region is often accompanied by local impaired mobility, gland damage, difficult in swallowing, and postoperative complication and seriously affects patients life quality. We reported a case of subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy for tongue lesions accompanied by impaired neck mobility and difficult in swallowing was treated using Fu's subcutaneous needling (FSN) treatment.

PATIENT CONCERNS

A 55-year-old male with tongue cancer received surgical intervention with lymphadenectomy 8 years ago was revealed a 15 cm-long curved surgical incision in the neck region and surrounded by numerous scar tissues.

DIAGNOSIS

Post-operation subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy was diagnosed.

INTERVENTIONS

FSN treatment was performed 2 to 3 times per week for 1 month to sway the affected tightened muscle and dissociate the superficial fascia beneath the scar resulted in a considerable improvement in neck movement.

OUTCOMES

The Vancouver Scar Scale (VSS) was as follows: color (M) - 1; vascular distribution (V) - 0, thickness (H) - 2, and flexibility (P) - 4, with a total of 7 points before FSN treatment. The VSS after 1 month of FSN treatment was as follows: M1, V0, H2, and P2, with a total of 5 points. Neck mobility in different directions, i.e., stretching to the back of the neck and laterally bending the neck to the left and/or right side, was improved (P < .05).

LESSONS

At present, treatment of chronic scar hyperplasia has certain side effects and limitations. FSN is safe and convenient, with minimal destruction of the superficial fascia, having evident effects of dissociating tissue adhesion under scars and compensating for deficiencies in scar hyperplasia treatment. It can provide new ideas for future treatments.

Treatment of syncope in tongue cancer with palliative chemotherapy in the intensive care unit: A case report

RATIONALE

Syncope caused by head and neck cancer (HNC) is rare. However, syncope caused by tongue cancer (TC) is even rarer. In TC, syncope is caused by tumor-mediated compression of the carotid sinus and stimulation of the glossopharyngeal nerve.

PATIENT CONCERNS

In this study, we report the case of a 48-year-old male patient who was diagnosed with advanced TC and bilateral cervical lymph node metastasis. On the third day of admission, the patient experienced recurrent syncope with hypotension and bradycardia.

DIAGNOSES

The patient was diagnosed with a well-differentiated squamous cell carcinoma of the tongue along with massive cervical lymph node metastasis and carotid sinus syndrome.

INTERVENTIONS

Initially, symptomatic treatment of syncope boosted the blood pressure and increased the heart rate. Thereafter, a temporary pacemaker was implanted. Finally, chemotherapy was used to control the tumor and relieve syncope.

OUTCOMES

After chemotherapy, the tongue ulcers and cervical lymph node reduced in size; syncope did not recur.

LESSONS

This case shows that chemotherapy may be a valid treatment option in patients with cancer-related syncope; however, the choice of chemotherapeutic drugs is critical. Intensive care provides life support to patients and creates opportunities for further treatment.

Ulcerated bleeding palisaded encapsulated neuroma of the tongue

INTRODUCTION

Palisaded encapsulated neuroma (PEN) is a benign lesion of Schwann cells and its occurrence in the oral mucosa especially the tongue is very rare.

CASE REPORT

This article describes a case of a 41-year-old male, a chronic smoker with an actively bleeding, ulcerated, solitary, firm lesion on the lateral border of the tongue which had bled thrice before. A differential diagnosis of pyogenic granuloma, haemangioma, fibroma, nerve sheath tumour, salivary gland tumour and malignancy was made and surgically excised. Histopathology of the excised specimen revealed a well-circumscribed lesion with spindle-shaped cells arranged in interlacing fascicles and with the help of immunohistochemical markers confirmed it to be a PEN.

DISCUSSION

To our knowledge, this is the first description of an ulcerated PEN presented with an active bleed.

Coexisting Congenital Subglosso-palatal Membrane and Tongue Dermoid in a Neonate

BACKGROUND

Neonatal respiratory distress due to coexisting subglosso-palatal membrane and tongue dermoid has not been reported yet.

CASE CHARACTERISTICS

A newborn with respiratory distress having a membrane in the oral cavity. Excision of membrane revealed a tongue mass with cleft palate, obstructing the nasopharynx completely. Elective ventilation was followed by excision of mass.

OUTCOME

The child was cured with uneventful course at follow-up of six months.

MESSAGE

Co-existing congenital anomalies causing airway obstruction may be missed in presence of subglosso-palatal membrane.

Cardiac metastasis of tongue squamous cell carcinoma complicated by pulmonary embolism: A case report

RATIONALE

Cardiac metastasis is known as a rare complication of head and neck malignancy.

PATIENT CONCERNS

We present a 58-year-old woman patient with a history of tongue carcinoma who was admitted in emergency department for sudden chest pain. Imaging work-up by computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) diagnosed a cardiac metastasis complicated by intraventricular thrombus and pulmonary embolism.

DIAGNOSIS

Cardiac metastasis from tongue carcinoma complicated by pulmonary embolism.

INTERVENTIONS

After undergoing 2 cycles of palliative chemotherapy, the patient declined any further treatment.

OUTCOMES

Patient died 3 months after the diagnosis of cardiac metastasis.

LESSONS

Cardiac metastasis should be considered as a differential diagnosis in patients with a history of head and neck malignancy who present non-specific cardiac symptoms.

Holt-Oram syndrome: Anesthetic challenges and safe outcome

Holt-Oram syndrome (HOS) is an autosomal dominant disease with skeletal and cardiac manifestations. We here are presenting a 31-year-old man and a diagnosed case of HOS, with an ulceroproliferative lesion on lateral border of the tongue, was posted for wide excision of lesion with primary closure and left side radical neck dissection.

[Anesthetic Management of Cesarean Section in a Pregnant Woman with Advanced Tongue Cancer]

It is very difficult to decide the best time to deliver the baby for a pregnant woman with advanced cancer. We experienced the perioperative and perinatal management of a 39-year-old pregnant woman with advanced tongue cancer. The cancer had already metastasized to the lung and lymph nodes. Furthermore a recurrent thumb-sized tumor was found in her mouth. She had firmly desired to discontinue all anticancer treatment for protecting the fetus. On the other hand, her family could not accept her determination yet. Therefore the medical team was organized with doctors and co-medicals from multiple departments such as gynecology, pediatrics, radiology, oncology, midwife, psychotherapy and anesthesiology. After several conferences including herself and family, finally cesarean section was scheduled for the 30th gestational week. Prepared for unexpected emergency delivery, airway stenosis was ruled out by fiberoptic laryngoscopy and the consent for emergency tracheostomy was obtained. The operation was performed successfully under spinal anesthesia without any severe troubles. Medical care as a team from early phase enabled elaborate observation and preparation through the perioperative and perinatal period. Furthermore, it was efficient to provide satisfaction to the patient and her family as well.

Granular cell (Abrikossoff) tumor in the head and neck: A series of 5 cases

We evaluated a series of 5 patients-3 men and 2 women, aged 39 to 70 years (mean: 54.4)-with a granular cell tumor (GCT) of the head and neck in an effort to better define the clinical presentation, imaging characteristics, and surgical management of this type of tumor. In all cases, the diagnosis was established by pathologic analysis. There were 2 cases of laryngeal GCT and 1 case each of GCT arising in the nostril, hypopharynx, and the tongue base. The clinical findings were variable, depending on the location and extent of each lesion. Four of these patients underwent endoscopic examination, and in 2 cases computed tomography was performed. Treatment included wide surgical excision of the lesion in all cases. Otolaryngologists should be familiar with this unusual tumor. Although an accurate preoperative diagnosis is extremely difficult to make, appropriate therapeutic intervention is associated with a cure rate that is quite high.

Gulossectomy and Skeletal Anchorage as Aajuncts to Orthodontic Correction of a Severe Open Bite Case

Etiology of open bite malocclusion is multifactorial; therefore, elimination of the main etiologic factor is the key for successful treatment. Tongue size and posture can cause open bite; thus, glossectomy is one of the treatment choices in severe cases. A 19 year old girl with a chief complaint of extra-large tongue and anterior open bite due to hemangioma was referred to us. Hemangioma removal and partial glossectomy were performed. With no other intervention, the anterior open bite decreased 10 millimeters within 3 years. Since the patient refused orthognathic surgery, the remaining malocclusion was resolved by orthodontic treatment using skeletal anchorage.

[Dynamics of morbidity of patients with malignant tumors of the tongue with regard to the stage of disease and histological structure of tumors (population-based study)]

INTRODUCTION

Malignant tumors of the tongue (C-01. 02) are relatively rare visual tumor sites. Incidence rate in men is usually 4-5 times higher than in women. To estimate a complex of analytical rates with respect to malignant tumors of the tongue (morphological level of verification, the distribution of patients by the stage of disease, to evaluate one-year and relative survival, etc. ) in accordance with the state report (F. №35) is impossible since malignant tumors of the tongue are not considered separately. Such research can be performed only on the basis of data of the population-based cancer registry.

PURPOSE OF THE STUDY

To study the prevalence, the detailed structure of morbidity, to estimate a number of analytical rates characterizing malignant tumors of the tongue.

MATERIALS AND METHODS

On the basis of materials of the International Agency for Research on Cancer (IARC), Statistical Handbooks of the P. A. Herzen Moscow Research Oncological Institute and database of the Population-based Cancer Registry of St. Petersburg there were studied all the aspects put in the purpose of the study, using a range of instructional techniques recommended by the International Association of Cancer Registries, which member we are at number 221.

RESULTS

This study showed that from 1970 to 2005 in various countries of the world the incidence rate (standardized rate the world standard) of malignant tumors of the tongue increased a little or maintained its level. In Russia it is possible to carry out such assessment only from 1989 to 2013. During this period the incidence rate of malignant tumors of the tongue has increased from 2,20/0000 till 2,30/0000 in men, and from 0,40/0000 and 0 ,50/0000 in women. In St. Petersburg-Leningrad since 1980 standardized rate of malignant tumors of the tongue has increased from 2,1 till 3,5 0/0000 in men or by 66. 6% and from 0,5 till 1,50/0000 in women three times more. Positive dynamics of survival rates of patients with malignant tumors of the tongue but a significant backlog from the European average retains.

An unusual presentation of a lingual dermoid cyst

Dermoid cysts are rare lesions of the head and neck that usually present in children as an asymptomatic, slowly growing mass. We report a case that demonstrates that dermoid cysts can present later in life as a recurrent acute infection. Our patient was a 48-year-old man with a 22-year history of recurrent abscesses of the tongue and floor of the mouth that had required a tracheotomy and multiple hospitalizations. Magnetic resonance imaging performed between acute episodes revealed the presence of a 1.8-cm lesion within the tongue musculature. The patient underwent resection, and pathology was consistent with a lingual dermoid cyst. At 2 years of follow-up, he experienced no recurrence of symptoms.

Co-existence of Carcinoma Tongue with Pulmonary Tuberculosis

We present the case of a 45-year-old male diagnosed to have carcinoma base of tongue, whose chest radiograph showed bilateral lung infiltrates and was referred for evaluation of suspected pulmonary metastases. Diagnostic evaluation confirmed the diagnosis of smear-positive pulmonary tuberculosis.

Lymphangiomatous macroglossia associated with extensive cervicomediastinal cystic hygromas

Children with lymphangiomatous macroglossia often have difficulty eating and talking, and their airways may be compromised because of bleeding and infection, especially when extensive cervicomediastinal cystic hygromas are present. We report a case of lymphangiomatous macroglossia associated with extensive cystic hygromas in the cervicomediastinal region. The 3-year-old girl was treated with anterior wedge reduction of the tongue, needle aspiration of the cervicomediastinal cystic hygromas, and systemic steroids and antibiotics. The extensive cystic cervicomediastinal hygromas spontaneously regressed, and further surgery was not needed until 4 years later. Surprisingly, subtotal or partial lymphatic malformation removal improved the complicated lymphatic malformation.

Living in limbo: Ethics and experience in a conversation about persistent oral lesions

This case report presents a conversation that the authors had with a patient who is suffering from oral lichen planus and oral cancer. The reason that the authors approached the patient for an interview was to find out why he decided to enroll in an experimental study related to his oral cancer. The patient reported that it was "the waiting" that led him to enroll in this study--that is, the pressure of waiting for oral cancer to reemerge was simply unbearable, and enrolling in this experimental study enabled him to take a more proactive approach to his illness. The authors view this "waiting" as a "limbo experience" and reflect on the implications of this limbo experience for dental ethics and research ethics.

Systemic lupus erythematosus, pregnancy and carcinoma of the tongue

We present a case which describes a 29-year-old woman with systemic lupus erythematosus who was treated aggressively with cytotoxic immunosuppression. Five years later and approximately 12 weeks pregnant, she is confirmed as having carcinoma of the tongue. Not wishing to consider termination of her pregnancy, she underwent surgical resection, which included partial glossectomy with microvascular reconstruction. Good oral function (speech and swallowing) was restored within 2 weeks. The pregnancy proceeded relatively uneventfully to 37 weeks gestation when proteinuric hypertension necessitated induction of labour. She remains well with no evidence of recurrence. This case highlights the options available in the treatment of carcinoma of the tongue during pregnancy together with the ethical considerations required, balanced against optimising maternal outcomes.

Oral changes stemming from hemangioma of the tongue

Hemangiomas are among the most common tumors found in children and are characterized by an excess of blood vessels. They most often affect the area of the head and neck, occur with greater frequency among women and Caucasians, and can be found in the oral cavity-especially on the lips, tongue, or mucosa. Clinically, hemangiomas present as asymptomatic red or blue-colored lesions that grow rapidly and are capable of spontaneous regression. When they are found on the tongue, they can result in clinical problems as well as recurrent trauma due to biting of the tongue and tooth-brushing, resulting in bleeding, obstruction of the upper airways, and difficulty with chewing, deglutition, and speaking. The purpose of this article was to present a case study of a 4-year-old child with a diagnosis of hemangioma of the tongue, emphasizing the oral changes found as a result of this lesion, as well as the dental treatment used to minimize these changes.

Long-term results of brachytherapy in early mobile tongue cancer with 10-year minimal follow-up

AIM

To retrospectively analyze the long-term toxicities of low-dose-rate interstitial brachytherapy (LDR-BT) with related prognostic factors for patients with early mobile tongue cancer (T1/2N0M0) at a minimum of 10 years' follow-up.

PATIENTS AND METHODS

The records of 187 patients treated with LDR-BT between 1980 and 2000, out of whom 25 were treated with additional prior external beam irradiation, were reviewed.

RESULTS

Overall survival at 15 and 20 years was 88.4% and 76.2%, respectively. Complications included tongue ulcer (26%), tongue erosion (3%), tongue atrophy (2%), bone exposure (15%), and osteoradionecrosis (4%). No patient presented xerostomia or taste disorders. Multivariate analysis revealed that tongue ulcer and the use of spacer were significantly associated with bone exposure and osteoradionecrosis. Local recurrence was demonstrated in 15 (8%) cases, 93% of which were salvaged by operation. Fifty patients (27%) experienced neck metastasis.

CONCLUSION

LDR-BT is an acceptable treatment option, with low rates of long-term toxicity.

Development of hemangioma in a tongue harboring long-standing angiokeratoma circumscriptum

Angiokeratoma is a very rare vascular lesion of the papillary dermis. It is characterized by vascular ectasia with overlying epidermal hyperkeratosis. The systemic form of angiokeratoma is associated with Fabry disease and fucosidosis. There are several localized forms. Tongue involvement is uncommon. Hemangiomas are tumors made up of capillaries; they grow by active endothelial proliferation as opposed to expansion of vascular spaces in vascular malformations. Lingual hemangiomas are usually indolent, but they can cause cosmetic deformities, recurrent hemorrhage, and functional problems with speaking, mastication, and deglutition. We report a case of angiokeratoma of the tongue with an underlying hemangioma in a 30-year-old woman. Angiokeratomas have been reported to develop over arteriovenous malformations and in the area of lymphangioma circumscriptum following repeated local trauma. To the best of our knowledge, the development of a lingual hemangioma in a patient with long-standing angiokeratomatous lesions has not been previously reported in the literature.

Tongue abscess: a rare clinical entity

Swelling of the tongue is a rare clinical entity. It is a potentially life-threatening condition, as it could result in airway compromise. The differential diagnosis of acute tongue swelling includes hemorrhage, infarction, abscess, tumor, and edema. A tongue abscess should be considered in all cases of acute tongue swelling, especially when host defenses are severely impaired. Although the diagnosis of lingual abscess can be reached clinically because of the rarity of the condition, in neglected cases, the diagnosis can be difficult. Despite of the rarity and complexity of this condition, its management strategy is relatively simple. In the present study, we describe a case of a tongue abscess on the anterior two-thirds of the tongue in a 60-year-old woman, and discuss the pathophysiology, diagnosis, and treatment of this complex entity.

Angiosarcoma arising from the tongue of an 11-year-old girl with xeroderma pigmentosum

Xeroderma pigmentosum (XP) is a rare autosomal recessive defect in DNA endonuclease activity that is associated with the development of cutaneous malignancies, at sun exposed sites, including basal cell carcinoma, squamous cell carcinoma, and melanoma. Squamous cell carcinomas are also known to target the anterior tongue. Patients sometimes develop angiosarcomas, and these invariably arise from sun-exposed skin. A biopsy was taken from a large mass arising in the anterior tongue of an 11-year-old girl with XP and a history of cutaneous basal cell carcinomas. The histopathologic findings demonstrated a high grade epithelioid neoplasm resembling a poorly differentiated squamous cell carcinoma, but the immunohistochemical profile (AE1/AE3 negative, p63 negative, CD31 positive, CD34 positive) established the diagnosis of angiosarcoma. Angiosarcoma is an XP-related tumor that usually arises in sun-exposed skin but can also arise in the oral cavity. For patients with XP who develop epithelioid neoplasms of the oral cavity, epithelioid angiosarcoma should be considered in the differential diagnosis.

Paraneoplastic vesiculobullous dermatomyositis with synchronic prostate and tongue tumors: case report

Dermatomyositis is an inflammatory myopathy with skin manifestations. In the adult over the age of 50 years, it can be associated with malignant neoplasias, being, thus, a signal of malignancy.

OBJECTIVE

To show the association of dermatomyositis of atypical presentation with two synchronous tumors, usually not related to that.

CASE REPORT

We report the case of a 72-year-old male, who developed dermatomyositis, initially with only classic skin findings, which progressed to vesiculobullous lesions, and, months later, to myopathy. After extensive investigation, prostate adenocarcinoma was diagnosed. After treatment of the cancer and administration of glucocorticoid, the disease went into remission. During gradual glucocorticoid withdrawal, dermatomyositis recurred, and the new investigation revealed the presence of squamous cell carcinoma of the tongue. After treating this neoplasia, complete remission occurred, even after total corticoid withdrawal.

CONCLUSION

This is a rare case involving less usual dermatomyositis presentation forms, relating to the cutaneous-muscle findings and the association with prostate and tongue tumors (tumors never reported together). This case demonstrates the importance of a careful investigation, searching for neoplasias, when approaching such patients.

Harmonic scalpel for a bloodless partial glossectomy: a case report

Tongue surgery is almost always complicated by intraoperative bleeding. Its rich blood supply especially from the lingual vessels makes the operative field bloody. Electrocautery has been widely used to replace cold scissors in order to achieve better hemostasis. The use of ultrasonic harmonic scalpel for glossectomy is still new in this country. We report a case of partial glossectomy using the harmonic scalpel in a patient who had a squamous cell carcinoma of the lateral border of the tongue.

Lymphangioma of the tongue with macroglossia: a case report

Lymphangioma are rare benign lesions of the lymphatic vessels, found mainly in the head and neck. Almost all cases of macroglossia in young children are caused by lymphangioma of the tongue. Aesthetic, occlusal, functional and psychosocial problems may arise as a result of this condition. The preferred treatment is surgery but in some cases sclerosant therapy may be used as an adjunct treatment. We report a case of lymphangioma of the tongue with macroglossia that was treated successfully with a Vshaped anterior glossectomy and discuss the surgical considerations.

Watermelon stomach, hemorrhagic pericarditis, small cell carcinoma of the lung and synchronous squamous cell carcinoma of the tongue base

Based on a case of gastric antral vascular ectasia (watermelon stomach) that was associated with hemorrhagic pericarditis, small cell lung carcinoma with mediastinal lymph node metastases and a synchronous squamous cell carcinoma of the base of the tongue, the authors made a review of the clinical, endoscopic and histopathological aspects of this type of gastropathy, and its association with other diseases, and of the results of its endoscopic therapy. The causes of hemorrhagic pericarditis are considered, emphasizing the necessity to know if the effusion has a malignant etiology. To the best of our knowledge the association of watermelon stomach to small cell lung carcinoma and squamous cell carcinoma of the base of the tongue has not yet been described. Extensive metastases to mediastal lymph nodes are common to small cell lung carcinoma.

Regional odontodysplasia involving three quadrants of the jaws: a case report

Regional odontodysplasia is a rare developmental anomaly of the teeth that affects enamel and dentin. Its etiology is unknown, but the most accepted theory refers to circulatory disorders associated with vascular nevi. An uncommon case of regional odontodysplasia involving three quadrants of the jaws is reported. An 8-year-old boy was referred to the authors' institution with lack of teeth as a major symptom. There was no hereditary anomaly in the family. Extraoral examination revealed a brown discoloration on the skin on the right side of the face, neck, and chest. Detailed intraoral examination showed hypoplastic and carious teeth. Fistulae and gingival overgrowth were also observed. Radiographically, the affected teeth presented the pathognomonic image of "ghost teeth." Conservative treatment was instituted.

One case of Candidemia developed after surgery for tongue cancer in a young adult

Candidemia is an opportunistic infection caused primarily by Candida albicans. We experienced a case of severe Candidemia that developed after surgical treatment for tongue cancer and required considerable labor to diagnose and to treat, though no particular immunodeficiency was seen before. The case was resistant to an antifungal agent, fluconazole, but was successfully treated with amphotericin B. Positive blood cultures, local wound culture, and increased β;-D-glucan were useful to diagnose the infection. In particular, gallium-67 scintigraphy was remarkably useful for the diagnosis and the evaluation of therapeutic effects in this case. Development of Candidemia following an oral and maxillofacial surgery is extremely rare among young adults, thus this case report serves to draw attention to the risk in oral and maxillofacial surgery.

[Diagnostic image. A woman with a swollen tongue]

A 46-year-old woman had a swollen tongue due to amyloid light chain (AL) amyloidosis caused by multiple myeloma.

The treatment of tongue haemangioma by plasma knife surgery

A seven-year-old girl presented with a 4 cm x 2 cm lesion of the tongue which was located at the posterior one-third in the midline. The lesion was excised by plasma knife surgery. No complication, such as bleeding, shortness of breath or infection, occurred after the treatment. Plasma knife surgery is an acceptable choice for selected benign lingual vascular malformations.

Macroglossia caused by adenoid cystic carcinoma. Case report

A 33-year-old woman sought medical care at our institution for macroglossia. She had been treated before with tracheostomy and gastrostomy due to an adenoid cystic carcinoma (ACC) of the mobile tongue, in clinical stage IVC. She was subjected to total glossectomy with larynx preservation, modified radical dissection of the right neck and of the left supraomohyoid muscle, as well as reconstruction using a free flap from the rectus abdominus. The histological report described a 15x11 cm solid type ACC of the mobile tongue (grade III), with infiltration to adjacent soft tissues, vascular and lymphatic vessels, as well as two metastatic lymph nodes in the right neck dissection. One month after surgery, bone and bilateral pulmonary tumor activity became evident. In advanced-stage tumors, treatment must be individualized, and when accompanied by severe deterioration of the quality of life, surgery is recommended independently from the extension, provided that a good reconstruction is accomplished.

Dental treatment planning and management in the patient who has cancer

The oral cavity has the potential to be a major source of short-term and long-term complications from cancer therapy. Appropriate evaluation and elimination of potential sources of oral infection before cancer therapy is vital because oral bacteria are a known source of bacteremia and septicemia during cancer therapy. Cancer diagnosis with previous and planned treatment, past medical history, past dental history, current medications, drug allergies, social history, family history, laboratory values, extraoral findings, intraoral findings, and radiographic findings must all be evaluated in planning dental treatment for these complex cases.

An alternative for postorthodontic labial retention in an unusual case

An integral part of sustaining long-term orthodontic results is a lingually bonded retainer. These retainers have been established as a standard retention protocol, as they combine efficiency and esthetics. Increasing patient demands for improved esthetics and maintenance of good health of dental and periodontal tissues have led to the development of new techniques and materials involving reinforced polyethylene fibers. In this case report, retention featuring the use of a reinforced polyethylene fiber retainer, placed labially to avoid irritating the tongue, is presented. Three-year posttreatment records indicated no relapse and that the integrity of soft and hard tissues had remained intact.

Analysis of Determinants on Speech Function After Glossectomy

PURPOSE

To determine which of the following factors-type of reconstruction, size of tumor, and site of excision-may influence speech intelligibility after glossectomy.

MATERIALS AND METHODS

The speech intelligibilities of 27 tongue cancer patients who underwent glossectomy within the range of the hemitongue were investigated within 6 months after operation with a speech intelligibility test formed by 100 sensitive Chinese sounds. They were compared according to the following factors: type of reconstruction (forearm flap or adjacent flap); size of tumor (T1, T2, T3); and site of excision (anterior, middle, posterior, or hemi part).

RESULTS

There was no significant difference in speech intelligibility between the forearm flap reconstructed group and adjacent flap reconstructed group (P > .05). There was a significant difference in the result between the T1 and T3 groups (P < .05). The speech intelligibilities of the patients with tumors in anterior tongue or hemitongue were significantly lower than those with tumor in the middle or posterior tongue (P < .05). Patients with preservation of the tip of the tongue or floor of the mouth had higher intelligibilities (P < .05).

CONCLUSION

For the patients after glossectomy within the range of hemitongue, except for the type of reconstruction, the tumor site or excision extent of the tongue followed by the tumor size may be key factors in determining the postoperative articulation intelligibility.

Carcinoma of the tongue and bulbar-onset amyotrophic lateral sclerosis: unusual differential diagnosis

We present a 72-year-old woman with progressive dysphagia, dysarthria and tongue palsy who was initially diagnosed with bulbar-onset amyotrophic lateral sclerosis (ALS). However, the absence of atrophy or fasciculations in the tongue, as in other voluntary muscles, and the lack of reproducible neurophysiological evidence of denervation, prompted a revision of the diagnostic work-up, which eventually led to the discovery of a carcinoma of the tongue. This case report describes a relatively rare type of oropharyngeal carcinoma that, in its early stage, resembled a bulbar-onset ALS. This differential diagnosis is unusual, and it was fostered by the persistent lack of atrophy of the tongue and the absence of spreading of signs and symptoms of motor neuron degeneration.

Implant-retained feeding aid prosthesis for a patient following total glossectomy and laryngectomy: a clinical report

This clinical report describes the prosthetic management of a patient following total glossectomy and total laryngectomy that severely compromised his oral function, caused facial disfigurement, and limited the patient's quality of life. A feeding aid prosthesis was designed to address the patient's chief complaint of difficulty in feeding and mastication. The prosthesis was designed as an implant-retained overdenture with a lingual metal plate to facilitate food introduction into the oropharynx. This treatment improved mastication, appearance, and the quality of the patient's social life.