One method for restoring the anterior floor of mouth defects resulting from T1 and especially T2 cancer excision involves the creation of a myomucosal island flap from the dorsal median portion of the tongue and transferring it as a transit flap to the floor of the mouth.

We are not the first to advocate this method. In this paper we present a previously unreported, slightly modified technique utilizing this tongue flap. The modification consists of a 90° twisting of the flap to achieve a more appropriate adaptation to the defect. In the case ofspreading carcinoma from the floor of the mouth to the central portion of the tongue, a similarparamedian one-sided tongue flap was created instead of a central island tongue flap. Our present experience consists of a small series of 12 patients. The procedures were successful in all patients. No remarkable disturbances of speech or deglutition were observed in any of the patients. There were two complications: one haematoma and one partial necrosis of the tip of the tongue. In our opinion, the reconstruction of the anterior floor of mouth defects using a central island tongue flap has not gained the popularity it deserves.

Quality of life issues in head and neck cancer have been portrayed increasingly in the medical literature in recent decades. Reports vary in sample size and study design but the majority are cross-sectional and suffer from inherent bias. Many of the patients’ complaints in cancer of the head and neck manifest close linkage to problems related to the oral cavity. Frequent specific problems are trismus, pain, xerostomia, and speech and swallowing disorders. Although quality of life is multifactorial and subjective, some improvement may be achieved by recognizing and addressing problems during the course of treatment. More longitudinal long-term studies are indicated in order to better define quality of life along the time axis.

Alterations of the p53 gene are the most frequently documented genetic abnormalities in human cancer. The aim of the present study was to analyse if this alteration is an early event in oral tumorigenesis and if the suprabasal expression of p53 is a marker of the presence and severity of epithelial dysplasia. Immunohistochemical p53 expression in 78 specimens of oral squamous cell carcinoma and non-tumoral adjacent epithelium was analysed. Non-tumoral epithelium was observed in 53 cases (67.9 per cent), being normal in six cases (7.6 per cent), hyperplastic in 24 cases (30.7 per cent) and dysplastic in 48 cases (61.5 per cent). Epithelial dysplasia was mild (23 cases, 47.9 per cent); moderate (23 cases, 47.9 per cent) and severe (two cases, 4.1 per cent). Twenty-one cases of the dysplasias (43.8 per cent) expressed p53. No p53 expression appeared in any normal epithelium. Basal p53 expression always appeared in mild dysplasias (two cases). Suprabasal p53 expression appeared in mild and moderate dysplasias in nine cases and in one severe dysplasia. No statistical correlation was observed between suprabasal expression of p53 and the presence or severity of the dysplasia. The expression of p53 is an early event in oral tumorigenesis but it does not behave as an objective marker of the presence or severity of epithelial dysplasia.

The TNM staging system is helpful but not enough to determine prognosis of the patients with squamous cell carcinoma of the oral tongue. T -stage alone is not suggestive for prediction of occult nodal metastases. For this reason, histopathological examination of 70 patients with squamous cell carcinoma of the oral tongue was done retrospectively. The histological differentiation, tumour thickness, perineural and lymphovascular space invasions, the amount of lymphocyte infiltration and pattern of tumour invasion were examined. Immunohistochemical examination was used to determine p53 immunoreactivity as well. The effect of these histopathological parameters and p53 immunoreactivity on nodal metastases and locoregional recurrence were analyzed using the chi-squared test. In terms of nodal metastases the only statistically significant difference between the two groups was tumour thickness, either <9 mm or >9 mm (p<0.05, χ2 = 17.182). Tumour thickness, perineural invasion, lymphovascular space invasion, the amount of lymphocyte infiltration all correlated statistically with locoregional recurrence (p<0.05, χ2 = 6.293 for tumour thickness; p<0.06, p = 0.054 for perineural invasion; p<0.05, χ2 = 8.689 for lymphovascular space invasion; p<0.05, χ2 = 5.320 for lymphocyte infiltration). The immunoreactivity of p53 correlated significantly with larger primary tumour size (p<0.05, χ2 = 5.440), lymph node metastases (p<0.05, χ2 = 4.093) and with pathological tumour stage (p<0.05, χ2 = 5.713). These results reveal that the above-mentioned histological parameters and p53 determination could be used for handling a specimen from an anterior tongue squamous cell carcinoma.

Morphometric measurements of nuclei may be of prognostic value in some cancers. In this present study we have evaluated the mean nuclear area (MNA) of 50 squamous cell carcinomas of the oral cavity (SCCOC) using computerized image analysis. Since chromosomal DNA content is a reflection of the DNA content in the nucleus, we have evaluated the relationship between MNA and chromosomal DNA. Thirteen tumours had a MNA greater than 49.9 μm2 and 37 had a MNA less than this. Six tumours were classified as hypodiploid, 29 as diploid and 15 as aneuploid. There were 44 node-negative patients and six node-positive. When comparing MNA in these groups, 50 per cent of node-positive patients had a larger MNA whilst only 20 per cent of the node-negative group had a large MNA. The correlation coefficient between MNA and DNA indices was r = 0.75. The greater nuclear size is possibly a reflection of a more aggressive tumour biology in the node-positive patients. We conclude that a large MNA may be a marker of aggressive tumour biology in this group. In the future, we aim to evaluate the prognostic significance of MNA in patients with SCCOC.

Sialadenoma papilliferum is a rare, benign, exophytic tumour of the salivary glands. The prognosis is exceptionally good. Since the lesion was first described, 30 cases have been reported in the English literature. and only one of these is known to have recurred.

A case of sialadenoma papilliferum occurring in the buccal mucosa with recurrence three years after local excision, is presented. The literature is briefly discussed.

A multivariant analysis of the value of the use of a pre-operative topical antiseptic mouthwash to reduce the incidence of post-operative wound complications in 106 consecutive patients undergoing head and neck surgery involving the oral cavity or oropharynx was carried out at the University of Iowa, Department of Otolaryngology-Head and Neck Surgery. An oral presentation employing povidone–iodine solution was used for 43 patients. The remaining 63 patients studied received no oral presentation. Unfavourable wound outcome was not associated with age, sex, presence and condition of teeth, or serious pre-existing medical illnesses. A significant correlation was found between post-operative wound breakdown and type of closure, stage of disease, and previous operation or radiotherapy. The use of an oral preparation correlated significantly with favourable wound outcome independent of all other variables (p<0.01).

Our data support the use of a topical antiseptic mouthwash to reduce the incidence of post-operative wound complications in surgery of the oral cavity and oropharynx.

In many cases of carcinoma of the floor of mouth, oncologic resection includes marginal mandibulectomy. Reconstruction poses a significant challenge. Requirements include coverage with thin but supple tissue to allow for dental implant or denture, and recreation of a mobile tongue and sensate floor of mouth gutter. Reconstructive efforts have ranged from skin grafts to free flaps, with variable success in fulfilling the above-mentioned requirements.

This paper describes the preferred technique of the author, in which external mandibular periosteum is saved and elevated with a submucosal flap of lower lip, raised to the level of the vermilion border. This flap is then advanced to ventral tongue. In this manner the entire anterior floor of mouth can be reconstructed.

Cases are presented demonstrating different aspects to the technique.

Defects caused by tumour excision in the floor of the mouth can be closed by different methods. We present thirteen cases treated in our department over the last seven years in whom naso-labial flaps were used. Twelve patients had squamous cell carcinoma of the floor of the mouth and one had fibro-sarcoma of the right lower mandible. Five received post-operative radiotherapy, one was resected following radiotherapy and seven were treated with surgery alone. Patient selection is important to give good functional results without compromising tumour clearance.

In the last six years, anterior mandibulotomy was used to approach tumours of the oropharynx and oral cavity in 39 cases. Twenty-six of these had primary lesions in the anterior two-thirds of the tongue. Eight cases had lesions in the base tongue, three in the cheek, and two in the tonsil. Twenty-six cases had T3 tumours, nine had T2 lesions, and four had T4 tumours. Twenty-five patients received post-operative radiotherapy. In 16 cases the mandibulotomy was combined with a marginal mandibulectomy. In 23 cases reconstruction was carried out using a pectoralis major myocutaneous flap. Adequate margins on histopathology obtained in all but eight patients. Bone-related complications occurred in only three patients, all of whom were previously irradiated. Thus the anterior mandibulotomy provides excellent exposure for oral and oropharyngeal tumours, with low complication rate, and avoidance of segmental mandibulectomy.

A personal series of 842 patients with a tumour of the oral cavity is presented. Five hundred and twelve of these patients had a histologically proven squamous cell carcinoma, and were previously untreated.

Increasing age was associated with worsening performance status. Women were older at presentation than men, and tumours of the upper part of the mouth were more common in the elderly, but there was no relation between age and histological grade or stage grouping.

Sex had no correlation with performance status or histological grade. However, men were more likely to have an advanced tumour, and tumours of the floor of the mouth and alveolus were much commoner in men.

There was no correlation between performance status and site or histological grade, but patients in poor general condition were more likely to have stage III-IV tumours.

Multivariate analysis showed that sex had no impact whatever on survival, but survival fell with increasing age and worsening performance status. The effect of age and performance status disappeared when the survival of treated patients was adjusted for deaths due to other causes.