The purpose of this study was to investigate the impact of treatment parameters on speech function and tongue motility in patients who have undergone oral (mobile) tongue resection for tongue cancer.
Speech function was assessed by a 100 Japanese syllable speech intelligibility test and conversation intelligibility test. Tongue motility was evaluated by time measurement of tongue masticatory movement. Patients were divided into two groups by approach of tongue resection: an intra-oral approach group (n=64) and a pull-through approach group (n=45). Each group was further divided into subgroups by treatment parameters.
All patients with intra-oral partial glossectomy revealed excellent speech intelligibility ranging from 91.7% to 93.6%. On the other hand, tongue mobility in the skin graft group was significantly lower than in the primary closure and artificial dermis group. In the pull-through approach group, patients with partial or hemi-glossectomy had good speech intelligibility, with mean scores ranging from 81.5% to 89.2%. However, speech intelligibility scores in the subtotal and total-glossectomy group were significantly lower, 65.1% and 37.4%, respectively. Patients with subtotal or total-glossectomy of the oral tongue had poorer speech function and tongue mobility.

View full abstract

Reconstruction after radical resection of oral cancer can be challenging. Reconstruction entails optimal recovery of appearance as well as adequate oral function including swallowing, eating and speech.
Free flaps have been used in patients with subtotal glossectomy.
The aim of this study was to conduct a functional evaluation of patients with tongue defect, based on the type of flap, the amount of glossectomy and the existence of suprahyoid muscle after resection to provide clinical suggestions for tongue reconstructions.
Tongue defects after glossectomy were reconstructed with a free flap in 61 patients from 2008 to 2013 at the Department of Oral and Maxillofacial Surgery, Keiyukai Sapporo Hospital. Seven patients were treated with partial tongue resection, 10 with unilateral resection of the movable part of the tongue, 7 with subtotal resection of the movable part of the tongue, 16 with unilateral resection of the tongue and 21 with subtotal resection, according to the classification of the Japanese Society of Oral Oncology （General Rules for Clinical and Pathological Studies on Oral Cancer: A Synopsis, Jpn J Clin Oncol 2012 doi:10.1093/jjco/hys141）.
Subjective functions were evaluated.
In this series, the functional outcomes of 58 patients were evaluated. The Mann-Whitney U test was performed to study the functional difference between groups.
Patients with glossectomy less than 2/3 of the total amount and with preservation of the suprahyoid muscle showed significantly better oral function.

View full abstract

The tongue plays a key role in oral functions such as mastication, speech and deglutition. The current treatment strategies for tongue carcinomas are mainly surgery-based comprehensive therapies. The principal goals of tongue reconstruction are both resurfacing the surgical defects and restoration of these functions. As far as oral functions after glossectomy are concerned, speech intelligibility is positively correlated with masticatory and swallowing functions. Mobility and the shape of the oral tongue are essential for oral functions, and mobility and the volume of the base of the tongue are critical for completing the pharyngeal phase of swallowing.
Therefore, the most important point for obtaining satisfactory oral functions after partial or hemi-glossectomy is to maximize mobility of the residual tongue and to maintain its shape and position within the oral cavity by a thin, pliable flap, such as a radial forearm free flap. This offers the freedom of flap placement without tethering of the remaining tongue. When the lateral pharyngeal wall is excised in conjunction with glossectomy, a narrower faucial isthmus is recreated to facilitate the pharyngeal phase of swallowing.
When tumor resection largely involves the oral tongue, or largely involves both of the oral and base of the tongue, a wide and thick flap such as a rectus abdominis musculocutaneous free flap is used to reconstruct a tongue with a protuberant shape and sufficient volume. Ancillary procedures such as laryngeal suspension, laryngoplasty, epiglottopexy and cricopharyngeal myotomy may be advocated to prevent aspiration and to facilitate postoperative swallowing.

View full abstract

The purpose of this study was to investigate the movement of the reconstructed tongue and to analyze the relations between the movement of the neotongue and postoperative swallowing function in patients with total or subtotal glossectomy. A common concept of total tongue reconstruction is to reconstruct a tongue in the protuberant shape to prevent aspiration. However, occupation of the oropharynges by the reconstructed tongue disturbs the swallow function. Therefore, the movement as well as the shape is important for tongue reconstruction.
In this investigation, videofluorography was conducted on 14 patients. Range of movement of the reconstructed tongue was measured with video-analysis software (DIPP-Motion Pro 2D^®). The relations between the movement of the reconstructed tongue and postoperative swallowing functions were analyzed statistically. The vertical movement distance of the reconstructed tongue had an influence on the swallowing function (P<0.05). In the patients with long-term follow-up, the tongue tended to move well. For the movement of the reconstructed tongue, the attachment of the flap to the palatoglossus muscle and the styloglossus muscle cut at the oropharynges was important. When these muscles were not preserved, fixation between the medial pterygoid muscle and the flap was effective.

View full abstract

We examined the clinical characteristics for 10 malignant lymphomas which presented the first symptom in the oral region. The mean age was 58.1 years, with a range of 23–88 years. The primary site of the tumor was the upper gingiva in 3 cases and the palate in 2. The initial symptoms were tumor mass and swelling in six cases, ulceration in two cases, and both swelling and ulceration in two cases. Five cases appeared to be in pain. The most common histopathological classification of the World Health Organization (WHO) was diffuse large B-cell lymphoma (DLBCL). According to the Ann Arbor staging classification, four cases were stage I, two were stage II, and four were stage IV. The outcome for these cases was that 8 of the 10 patients were alive after the treatment or observation.
In addition, in a review of the Japanese literature, 140 well-documented cases of malignant lymphoma in the oral region were analyzed. The common primary sites were the gingiva and palate. The initial symptom tended to be tumor mass or swelling. Because of difficulty in diagnosing malignant lymphomas of the oral region, 17.1% of the cases required multiple biopsies to make the diagnosis. In particular, the cases with ulcer or necrosis could not be definitely diagnosed. In most cases, the histopathological diagnosis was DLBCL, followed by mucosa-associated lymphoid tissue (MALT) and extranodal natural killer (NK)/T-cell lymphomas, and most of the cases were stage I (approximately 40%).

View full abstract

We performed a clinico-statistical investigation of 73 patients who were diagnosed with minor intraoral salivary gland tumors at our department.
The incidence of benign and malignant tumors was approximately equal. There were no statistically significant differences in the age or gender of the patients with benign or malignant tumors. Histologically, pleomorphic adenoma was the most common type of benign tumor, while mucoepidermoid carcinoma and adenoid cystic carcinoma were the major types of malignant tumor. The palate was the most common site. The retromolar region showed the highest incidence of malignant tumors.
The diagnostic concordance rate was 87.1% in patients with malignant tumors. Almost all of the cases with diagnostic inconsistency involved the misdiagnosis of mucoepidermoid carcinoma as squamous cell carcinoma. These results suggested that clinicians must consider the possibility of intraoral minor salivary gland carcinoma in the diagnosis of intraoral tumors.
All of the stage I, II and III tumors were surgically treated. In contrast, 75.0% of the stage IV tumor patients received combined pre-/postoperative radiotherapy and chemotherapy. The cumulative survival rates for all malignant tumor patients were 83.1% at 5 and 10 years. Stage IV malignant tumors were associated with a significantly poorer prognosis in comparison to the other groups. The patients with an advanced tumor stage or locoregional relapse and distant metastasis showed a worse prognosis. New therapeutic options, including particle beam therapy and molecular target drugs, should be investigated for to improve the treatment outcome of patients with malignant salivary gland tumors.

View full abstract

We report a case of multiple oral cancer whose life was prolonged by radiotherapy with cetuximab for trachea invasion due to metastasis of the upper mediastinal lymph node.
A 79-year-old woman with a history of several times of oral cancer and cervical lymph node metastasis was referred to our department for the complaint of hoarseness and hemoptysis. Computed tomographic imaging revealed trachea invasion due to metastasis of the right upper mediastinal lymph node. Chemotherapy (Cisplatin+5-FU+cetuximab) was considered at first. However, in consideration of the advanced age and severe adverse reactions, radiotherapy with cetuximab was performed eventually. The patient showed no signs of recurrence or metastasis during nine months of follow-up. However, the patient developed right lung metastatis at ten months and eventually died due to respiratory failure fourteen months after treatment initiation.

View full abstract

Mucoepidermoid carcinomas frequently occur in the minor salivary and parotid glands, but rarely occur in the sublingual glands. As these carcinomas do not exhibit sufficiently distinctive clinical features, a prompt histopathological diagnosis is important for effective treatment. Here, we report a rare case of low-grade mucoepidermoid carcinoma arising from the sublingual gland. A 47-year-old man was referred to our department with the chief complaint of swelling on the right oral floor. Clinical examination revealed a hard and painless elastic mass on the right sublingual gland. On computed tomography and magnetic resonance imaging, a sharply circumscribed oval lesion was observed in the right sublingual gland area. Following a biopsy, low-grade mucoepidermoid carcinoma was diagnosed, and the lesion was excised. On histopathological analysis, the sublingual gland tumor consisted of proliferative dermoid, intermediate, and mucous cells. No evidence of recurrence or symptoms has been seen 1 year and 9 months since the operation.

View full abstract