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PubMed1994

Mandible preservation in cancer of the floor of the mouth. Anatomical and oncological considerations.

An extended marginal mandibulectomy can be performed in most T2-T3 carcinomas of the floor of the mouth that abut the anterior mandible if there is no radiologic evidence of bony invasion or clinical evidence of fixation. We propose a modification of the marginal mandibulectomy that maintains viability to the anterior mandibular remnant and thus decreases the morbidity associated with a loss of blood supply. This modification permits preservation of a viable mandibular remnant with significantly less loss of function than with the traditional segmental mandibular resection, while remaining oncologically sound.

Adult↗

PubMed1979

Midline cancer of the floor of the mouth: role of suprahyoid dissection.

Of 37 patients with squamous cell carcinoma of the floor of the mouth seen during a 5-year period, 28 were treated primarily by surgery. Ten of the 28 patients presented with midline cancers measuring between 1.0 and 3 cm (T1 and T2). Three of these patients had local excision only. Metastases to the submandibular lymph nodes later occurred in 1 of these 3 patients. The remaining 7 patients with midline lesions had wide excision of the tumour, marginal resection of the mandible and bilateral suprahyoid node dissection. Of these 7 patients 4 remained free of disease for periods ranging between 2 and 5 years. Two of these had lymph node metastases. These results suggest that en bloc excision of relatively small midline cancers (i.e. not exceeding 2 cm (T1) in largest diameter) with bilateral suprahoid node dissection gives effective control of these lesions.

Adult↗

PubMed1985

Radial forearm flap for floor of mouth reconstruction.

Approaches to reconstructing floor of mouth defects are reviewed including methods of bony reconstruction following mandibular resection. The place of the free radial forearm flap, incorporating vascularized hemiradius if necessary, is described together with the anatomy, operative technique and a review of seven cases. It is concluded that this flap is an important addition to current methods of reconstructing substantial intraoral soft tissue defects alone or associated mandibular defects as well, owing to the high quality of results and to its low morbidity.

Adult↗

PubMed2001

A case of primitive floor of the mouth paraganglioma in a child: an embryological theory unifying viscerocranium appended paragangliomas.

BACKGROUND: Paragangliomas are unusual tumors in the head and neck originating from the paraganglia or glomus cells of neural crest origin. METHODS: We describe the first case of a primitive paraganglioma of the floor of the mouth presenting in childhood. RESULTS: Complete surgical removal was performed after embolization of the left lingual artery. There was no evidence of either persistent or recurrent disease 5 years after surgery. The embryologic and anatomic origins of head and neck paragangliomas are reviewed. CONCLUSIONS: An embryologic theory based on the common neural crest origin and migration pathways of both autonomic viscerocranium appended ganglias and paragangliomas is proposed that unifies the topographically heterogeneous group of viscerocranium-appended paragangliomas.

Child↗

PubMedDate not supplied

Radiotherapy after excisional biopsy of carcinoma of the oral tongue/floor of the mouth.

This is an analysis of 16 patients with excisionally biopsied (TXN0) squamous cell carcinoma of the oral tongue (nine patients) and floor of mouth (seven patients) treated with radiotherapy. All patients had a minimum 2-year follow-up and 81% had at least 5 years of follow-up. One patient died of intercurrent disease 16 months after treatment and was excluded from analysis of local control. All patients were evaluable for analysis of survival and complications. Local control was achieved in 14 of 15 patients; one patient with local recurrence underwent a surgical salvage procedure, which was unsuccessful. No patients developed recurrent disease in the neck or in distant sites. Five-year absolute and cause-specific survival rates were 10 of 13 and 10 of 11, respectively.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Management of squamous cell carcinoma of the floor of mouth.

Between 1964 and 1987, 194 patients with previously untreated squamous cell carcinoma of the floor of mouth were managed at the University of Florida. A retrospective analysis was undertaken in order to evaluate the treatment results and associated complication rates. Surgery or irradiation alone was found to result in similar local control rates for stage I and II lesions, whereas more advanced tumors had better local control rates with a combination of surgery and irradiation. Radiotherapy had a higher incidence of minor and moderate complications, whereas a greater number of severe complications occurred after surgery. We recommend surgery for early lesions due to the lower overall incidence of associated complications. Despite a higher risk of severe complications, combination therapy is recommended for more advanced lesions due to improved local control as compared to single modality therapy.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Prediction of cervical lymph node metastasis in squamous cell carcinoma of the tongue/floor of mouth.

BACKGROUND: Cervical lymph node metastasis has a major influence on survival in oral cancer. However, the factors influencing its occurrence are uncertain. Our aim was to improve the prognostic efficiency of the histologic assessment of the primary tumor in predicting metastasis in an individual patient. METHODS: The relationship between selected clinical and histologic features of the primary tumor of tongue/floor of the mouth and the actual metastatic status was investigated in 45 patients. Invasive cell grading was supplemented by histologic measurements of tumor size and assessments of vascular and perineural invasion. RESULTS: Ten histologic features showed significant differences in relation to metastasis. A logistic regression model with two predictor variables (total histologic malignancy score and vascular invasion) classified correctly 39 (87%) of the 45 cases. CONCLUSIONS: Histologic assessment of tumor size and malignancy grade are useful in predicting metastasis. Vascular and perineural invasion are important predictors and should be included in multifactorial malignancy grading schemes. Application of the prognostic index to the biopsy specimen would aid in treatment planning.

Adult↗

PubMedDate not supplied

Surgical approach to squamous carcinoma confined to the tongue and the floor of the mouth.

This retrospective study concerns 105 patients treated between 1977 and 1981 who had resections of previously untreated squamous carcinomas that were localized to the oral tongue or the floor of the mouth. Almost 80% had simple peroral excisions. Elective lymphadenectomy was performed in about one-third, all but one of whom had either T2 or T3 primaries or a surgical approach that involved entry into the neck. The determinate "cure" rate at 24 mo (median follow-up 50 mo) was 86%. Ninety-three percent and 78%, respectively, of those with T1 and T2 lesions remained alive and well after conservative operations, which yielded good functional results. Uncontrolled neck disease was evident in 10 of the 13 determinate patients who died as a result of their tumor. Although more of our patients with localized oral cancer now undergo elective lymphadenectomy when the primary is resected, T staging has not accurately predicted which patients are at greatest risk of metastasis. Preliminary data suggest that measurement of tumor depth may be a better way to select those patients who need elective neck therapy.

Adult↗

PubMedDate not supplied

Incidence of Wharton's duct stenosis in floor of the mouth cancers excised with scalpel or cautery vs CO2 laser.

Surgery of the floor of the mouth (FOM) using a scalpel or cautery has produced stenosis of Wharton's duct, necessitating further surgery because of painful enlargement to the gland or suspected metastasis. The laser has been proposed as an alternative method that might avoid this complication. A retrospective study comparing these excisional techniques was done at Walter Reed Army Medical Center between 1973 and 1983. Of a total of 58 lesions, 35 were T1N0M0 and 23 were T2N0M0 (two synchronous lesions being present). Of 35 lesions excised with a scalpel, 11 had an associated submandibular gland resection. Of the remaining 25, two developed secondary duct stenosis. Of 10 lesions excised with cautery, three had an associated excision of the submandibular gland. Of the remaining seven, two developed stenosis and one required subsequent excision of the gland. Of 12 lesions excised with laser, four developed stenosis and two required subsequent excision of the gland. Laser excision appears to be of no advantage in avoiding further surgery of the submandibular gland. A submandibular gland resection at the time of the original resection of T1N0 or T2N0 cancers of the FOM does not appear warranted.

Constriction, Pathologic↗

PubMed1989

A case-control investigation of cancer of the oral tongue and the floor of the mouth in southern India.

A case-control study of cancer of the oral tongue and floor of mouth was conducted in Kerala, Southern India, on 228 cases and 453 hospital-based controls, matched for age, sex and religion. We studied pan(betel)-tobacco-chewing, bidi (local type of cigarette)-and-cigarette-smoking, alcohol-drinking and snuff use, for their associations with risk, in males. Among females, only pan-tobacco-chewing was analyzed, as very few females indulged in the other habits. In males, a significantly increased risk was observed in association with pan-tobacco-chewing, bidi-smoking, bidi-plus-cigarette-smoking (but not cigarette-smoking alone) and alcohol-drinking (p less than 0.001 in all cases), although the effect of alcohol was no longer significant when adjusted for the other significant predisposing factors. Among females, pan-tobacco-chewing had a similar predisposing effect to that observed in males (p less than 0.001). In males an adjusted relative risk of 6.14 was associated with chewing 10 or more pan-tobacco quids per day (relative to those who never chewed). The corresponding relative risk in females was 9.27. In males, an adjusted relative risk of 7.46 was observed for those smoking 20 or more bidis per day (relative to never-smokers).

Age Factors↗

PubMed2006

DNA vaccination against foot-and-mouth disease via electroporation: study of molecular approaches for enhancing VP1 antigenicity.

BACKGROUND: Foot-and-mouth disease virus (FMDV) affects susceptible livestock animals and causes disastrous economic impact. Immunization with plasmid expressing VP1 that contains the major antigenic epitope(s) of FMDV as cytoplasmic protein (cVP1) failed to elicit full protection against FMDV challenge. MATERIALS AND METHODS: In this study, mice were immunized via electroporation with four cDNA expression vectors that were constructed to express VP1 of FMDV, as cytoplasmic (cVP1), secreted (sVP1), membrane-anchored (mVP1) or capsid precursor protein (P1), respectively, to evaluate whether expression of VP1 in specific subcellular compartment(s) would result in better immune responses. RESULTS: Electroporation enhanced immune responses to vectors expressing cVP1 or P1 and expedited the immune responses to vectors expressing sVP1 or mVP1. Immunization of mice via electroporation with mVP1 cDNA was better than sVP1 or cVP1 cDNA in eliciting neutralizing antibodies and viral clearance protection. Vaccination with P1 cDNA, nonetheless, yielded the best immune responses and protection among all four cDNAs that we tested. CONCLUSIONS: These results suggest that the antigenicity of a VP1 DNA vaccine can be significantly enhanced by altering the cellular localization of the VP1 antigen. Electroporation is a useful tool for enhancing the immune responses of vectors expressing VP1 or P1. By mimicking FMDV more closely than that of transgenic VP1 and eliciting immune responses favorably toward Th2, transgenic P1 may induce more neutralizing antibodies and better protection against FMDV challenge.

Animals↗

PubMed2025

Molecular Epidemiology of Coxsackievirus A10 Associated With Hand, Foot and Mouth Disease From 2021 to 2024 in Shenzhen, China.

The study aimed to investigate epidemiological profile and molecular characteristics of coxsackievirus A10 (CVA10) associated with hand, foot and mouth disease (HFMD) in Shenzhen, China and comparatively analyze genomes of CVA10 strains related to differential clinical phenotypes. A total of 3170 clinical specimens collected between 2021 and 2024 were examined for CVA10 using real-time RT-PCR. Complete VP1 sequences and near-complete genome sequences of CVA10 were determined by RT-PCR methods and sequencing. Sequences were analyzed using a series of bioinformatics programs. Two (33.33%) out of 6 severe cases were infected with CVA10. The detection rate of CVA10 associated with mild HFMD ranged from 1.21% to 6.11% in 2021-2024, with an overall detection rate of 3.73%. There was no significant difference in the infection rate of CVA10 between males and females or different age groups. The CVA10 infections mainly occurred in Spring (March to May) and Summer (June to August) in Shenzhen. Of the 74 VP1 sequences determined, 71 (95.95%) of them were detected in the sub-genotype C2, 3 (4.05%) were assigned to the genotype D. Genomic sequence analysis indicated that the genotype D of CVA10 of this study derived from genetic recombination between CVA10 and CVA16 in 3A-3D coding region (nucleotide position: 5075-6896). Different variable sites were observed in the two CVA10 strains associated with different severe complications when compared to CVA10 strains associated with mild diseases. In conclusion, CVA10 associated with HFMD circulated at a low level in Shenzhen in 2021-2024, with C2 as the predominant genotype. Recombinant genotype D of CVA10 was introduced first to Shenzhen in 2024. The study emphasizes the importance of continuous molecular surveillance of CVA10.

Humans↗

PubMed2026

Genetic Variation and Evolutionary Characteristics of Coxsackievirus B1: F3 Subtype Associated With Hand, Foot and Mouth Disease in China.

Coxsackievirus B1 (CV-B1) is primarily associated with meningitis but can also cause localized outbreaks of hand, foot, and mouth disease (HFMD). This study analyzed the genetic diversity of the VP1 gene in 39 strains of the CVB1 virus isolated from HFMD children across 15 provinces in China between 2010 and 2024, as well as 179 strains from 17 countries. Based on the average nucleotide difference of VP1 gene, we classified CVB1 virus into six genotypes A to F, Notably, genotype F is newly classified. Since 2010, genotype F guadually replaced genotype E as the dominant genotype in China and has further subdivided into three subtypes: F1, F2, and F3, with F3 being the most prevalent subtype in China currently. We specifically study the mild and severe cases within the F3 subtype. Temperature-sensitivity experiments revealed no differences between mild and severe cases of the F3 subtype, and they all belong to temperature-sensitive strains. Interestingly, we found that mild cases of the F3 subtype did not involve recombination, whereas all severe cases of the F3 subtype showed recombination with Coxsackievirus B4 (CVB4). CVB4 has consistently been the primary pathogen responsible for severe neonatal illnesses, suggesting that recombination between the F3 subtype and CVB4 may be associated with the development of severe HFMD. These findings provide fundamental scientific data for further investigation into the epidemiology and genetic characteristics of variants of Coxsackievirus B1 in China.

Humans↗

PubMed1978

"Localized" carcinoma of the mobile tongue and floor of the mouth--a lesion frequently misjudged and undertreated.

A retrospective study of 74 cases of cancer of the mobile tongue and floor of the mouth, diagnosed between 1949 and 1975, with a two-year minimum follow-up was undertaken. The lesions were TNM staged, stages I and II accounting for 56 cases (76%) and stages III and IV accounting for 18 cases (24%). The analysis was restricted to the "localized" stage I and stage II lesions. In this group failure occurred in 31 patients, or 55% of the group. Failure at the primary site accounted for 10 of the failures, failure at both primary and cervical lymph nodes accounted for 14, and failure at cervical lymph nodes only accounted for 7 of the failures. The treatment for these "localized" lesions was then analyzed for modality, adequacy, presence or absence of planning failure, and survival. The results indicate the lethal nature of this lesion when inadequately treated and strongly suggest more extensive use of prophylactic therapy to the cervical lymph nodes.

Animals↗

PubMed1982

Mandible preservation in the treatment of cancer of the floor of the mouth.

A segmental anterior mandibulectomy causes severe functional disability and cosmetic problems. Many methods of reconstruction have been used but none of these procedures provides the ideal solution. There has been increasing interest in the possibility of preserving a portion of the anterior mandibular arch and still carrying out an adequate surgical excision to control the primary tumor. Over a 15-year period, 251 patients with cancer of the floor of mouth were seen and treated at Roswell Park Memorial Institute. Of this group, 34 patients underwent a marginal mandibular resection as part of their curative surgical treatment. The complication rate was acceptable and the 5-year determinate survival rate was 84%. The local control rate was excellent with only one patient developing an intraoral recurrence which was successfully treated with radiation. It is felt that these data support the theory that conservative mandibular surgery can be carried out in selected cases without jeopardizing the concept of a good cancer operation.

Carcinoma, Squamous Cell↗

PubMed1985

Multiple primary cancers of the respiratory tract: a case of synchronous carcinoma of the larynx, carcinoma of the floor of the mouth, and dual primary bronchogenic carcinomas.

Multiple primary cancers of the respiratory tract are no longer considered uncommon. We describe a patient with synchronous carcinoma of the larynx, carcinoma of the floor of the mouth, and dual primary bronchogenic carcinomas. The clinical presentation, course, and treatment of this condition are discussed. Clinicians should be aware that multiple primary cancers of the respiratory tract are being reported more frequently and any tumor of this area demands a detailed examination of the entire tract at the time of diagnosis and careful, regular follow-up.

Adenocarcinoma↗

PubMed1986

Proposed method to study the factors affecting local control with combined external beam and interstitial implantation of mobile tongue and floor of mouth.

Twenty-seven patients with squamous cell carcinoma of the mobile tongue and floor of the mouth were treated with external beam and interstitial radiation. Good prognostic factors were T1N0, T2N0, superficial tumors, tumor shrinkage by 75% with external beam, and no apparent tumor clinically 2 months after treatment. On the other hand, T3N0, T1-3N1, and deeply necrotic tumors had a poor prognosis. We recommend using a flexible afterloading system to implant the initial local tumor volume (not just the residual nidus) that does not exceed 45 cm3. The minimum (reference) dose was prescribed to a surface 1/2 cm beyond the most peripheral rim of radioactive sources. For acceptable local control and complication rates, our suggested minimum (reference) doses are less than or equal to 7,500 rads for T1 (or a time-dose-fractionation [TDF] of 131-140), less than or equal to 8,000 rads for T2 (TDF of 131-140), and probably less than 8,500 rads for T3 (TDF of less than or equal to 150). These guidelines should be considered preliminary.

Brachytherapy↗

PubMed1988

Metastatic spread of floor of the mouth squamous cell carcinoma via pectoralis major myocutaneous flap.

In a patient with recurrent head and neck squamous cell carcinoma, reconstruction of the floor of the mouth was carried out by transposition of a pectoralis major myocutaneous flap after composite resection. Twelve months after surgery, a chest wall metastasis corresponding to the site of the vascular pedicle was observed. It appears that the lymphatic and hematogenous tumor spread can occur along the vascular pathways of a transposed myocutaneous flap.

Adult↗