Beyond the boundaries of compartmental hemiglossectomy: a proposal for an anatomically based classification of surgical approaches to advanced oral tongue squamous cell carcinoma

Gazzini, Luca; Fazio, Enrico; Dallari, Virginia; Spirito, Luca; Abousiam, Monir; Nocini, Riccardo; Nebiaj, Aurel; Giorgetti, Giovanni; Calabrese, Luca

doi:10.1007/s00405-023-07915-z

Cited by 7 publications

(2 citation statements)

References 24 publications

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“…At this point, the macroscopic invasion of the contralateral genioglossus muscle can be assessed under direct vision. We describe thereby the surgical approach to the contralateral compartment of the tongue ( 7 ): The first step is the detachment of the insertion of the contralateral genioglossus muscle from the mental symphysis. The contralateral lingual artery is identified by using the genioglossus muscle surface as the dissection plane to locate it.…”

Section: Methodsmentioning

confidence: 99%

Subtotal glossectomy with conservation of the hyo-styloglossus unit (HSU): a new pivotal concept for preserving tongue function in extended glossectomy

Gazzini,

Caselli,

Dallari

et al. 2024

Front. Surg.

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ObjectiveThe local spread of oral tongue squamous cell carcinoma (OTSCC) follows pathways of dissemination along areas of lesser resistance. In more advanced scenarios, the tumor can extend beyond the hemi-tongue of origin, by passing through the lingual septum and following the fibers of the transverse muscle. This can lead to the invasion of the contralateral extrinsic muscles, the first being the genioglossus and more laterally the hyoglossus. An anatomically guided surgical resection of the tumor can be planned to ensure both oncological safety and an acceptable functional outcome. This approach aims to preserve the hyo-styloglossus unit (HSU) whenever feasible.MethodsBetween January 2019 and November 2022, six patients received extended glossectomy Type B (EG Type B), with preservation of the HSU. Preliminary oncological results and functional results in terms of swallowing (FOIS score) and quality of life (MDADI) are presented.ResultsFive out of the six patients are alive and disease-free, while one patient died due to other causes. All patients who were candidates for an EG Type B underwent a swallowing assessment prior to surgery and followed daily postoperative swallowing training. At discharge, the patients continued swallowing training in an outpatient clinic. Five out of the six patients reached a full oral diet within 1 year of follow-up.ConclusionThe oncological results confirm the safety of this technique. The importance of preserving the HSU, the minimal functional unit, shows very encouraging results in terms of swallowing rehabilitation.

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Section: Methodsmentioning

confidence: 99%

Subtotal glossectomy with conservation of the hyo-styloglossus unit (HSU): a new pivotal concept for preserving tongue function in extended glossectomy

Gazzini,

Caselli,

Dallari

et al. 2024

Front. Surg.

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“…Based on the data gathered in our systematic review, we formulated a reconstructive algorithm for minimally-invasive reconstructive options, taking into account the site and size of the defect. Specifically, local options are preferable when defects are not extensive and do not involve multiple tissue types 79 , such as bone segments or large muscular volumes ( Fig. 5 ).…”

Section: Proposal For a Reconstructive Algorithmmentioning

confidence: 99%

Systematic review of minimally-invasive reconstructive options for oral cavity defects

Calabrese,

Fazio,

Bassani

et al. 2024

Acta Otorhinolaryngol Ital

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SUMMARY The oral cavity is a primary site for malignant neoplasms of the head and neck region. Surgery, with or without adjuvant therapy, offers the highest probability of cure by focusing on radical tumour removal and organ function restoration. Reconstructive options are represented by local and free flaps, while small defects can be managed without reconstruction. For medium-sized defects without bone involvement, local flaps can be a good alternative to free flaps in selected patients. The purposes of this article are to analyse the main minimally-invasive reconstructive techniques in oral cancer surgery through a systematic review of the literature and develop a reconstructive algorithm based on the site and size of the defect. We defined minimally-invasive reconstruction as any reconstructive option not involving flap dissection from the neck or other distant areas from the oral cavity. Options considered include: local myo-mucosal or mucosal flaps (based on the facial or buccal arteries, and palatal flap), Bichat’s fat pad flap, and nasolabial flap. Use of biological or synthetic materials is also described. In selected patients with small to moderate-sized defects, the possibility of reconstruction with local flaps can be a viable option.

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Phosphate level changes in oral cancer patients – recognizing the risk for refeeding syndrome

Silén,

Wilkman,

Haukilehto

et al. 2024

Eur Arch Otorhinolaryngol

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Purpose Patients with oral squamous cell carcinoma (OSCC) often have difficulties in obtaining sufficient nutrition and may develop refeeding syndrome (RFS) during hospitalization. RFS may be fatal if not treated properly. This study clarified changes in perioperative phosphate levels and occurrence of RFS symptoms in OSCC patients to identify clinically notable predisposing factors for RFS in this specific patient population. Methods A retrospective analysis included primary OSCC patients with microvascular free flap reconstruction. Patients with treatment for additional malignancy, hypoparathyroidism, and missing values of preoperative and/or postoperative plasma phosphate (P-Pi) concentration were excluded. The outcome variable was severe postoperative hypophosphataemia (mmol/l) during the postoperative period (P-Pi < 0.50 mmol/l). Predictor variables were age, sex, smoking, heavy alcohol use, diabetes, body mass index (BMI), weight, height, tumour site, tumour size, tracheostomy, nutritional route, and preoperative P-Pi concentration. Results Of the 189 patients with primary OSCC, 21 (11%) developed severe hypophosphataemia. Of these patients, 17 (81%) developed RFS symptoms. Higher age (p = 0.01), lower patient height (p = 0.05), and no current smoking (p = 0.04) were significantly associated with postoperative hypophosphataemia. In multivariable regression analyses, higher age (OR 1.06 per year) and age over 70 years (OR 3.77) were independently associated with development of severe hypophosphataemia. Conclusion Restoration of nutritional balance and close follow-up of electrolyte balance in the perioperative phase are necessary to prevent RFS, especially in patients with oral cancer requiring extensive reconstructions. Special attention should be focused on elderly patients since they are prone to this unnoticeable but potentially life-threatening electrolyte disturbance.

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Beyond the boundaries of compartmental hemiglossectomy: a proposal for an anatomically based classification of surgical approaches to advanced oral tongue squamous cell carcinoma

Cited by 7 publications

References 24 publications

Subtotal glossectomy with conservation of the hyo-styloglossus unit (HSU): a new pivotal concept for preserving tongue function in extended glossectomy

Subtotal glossectomy with conservation of the hyo-styloglossus unit (HSU): a new pivotal concept for preserving tongue function in extended glossectomy

Systematic review of minimally-invasive reconstructive options for oral cavity defects

Phosphate level changes in oral cancer patients – recognizing the risk for refeeding syndrome

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