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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 1  |  Issue : 1  |  Page : 52-53

Squamous cell carcinoma of the anterior two-third of tongue


Department of Oral and Maxillofacuial Surgery, The Oxford Dental College, Bengaluru, Karnataka, India

Date of Submission30-Apr-2016
Date of Acceptance13-May-2016
Date of Web Publication2-Jun-2016

Correspondence Address:
Vishal Dhirajlal Modha
19, Shri Nanjudeshwara Residency, 7th Main Hongasadra, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2456-1975.183287

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  Abstract 

Tongue is the most common site for oral squamous cell carcinoma. The various treatment options for carcinoma of anterior tongue are wide excision, hemiglossectomy and primary excisions along with elective neck dissection. Here we show report of a case of carcinoma of anterior tongue.

Keywords: Anterior tongue, neck dissection, squamous cell carcinoma


How to cite this article:
Umesh K, Vidya B, Modha VD, Manawar SB. Squamous cell carcinoma of the anterior two-third of tongue. BLDE Univ J Health Sci 2016;1:52-3

How to cite this URL:
Umesh K, Vidya B, Modha VD, Manawar SB. Squamous cell carcinoma of the anterior two-third of tongue. BLDE Univ J Health Sci [serial online] 2016 [cited 2020 Sep 21];1:52-3. Available from: http://www.bldeujournalhs.in/text.asp?2016/1/1/52/183287

The tongue is the most common site for oral squamous cell carcinoma. Male to female ratio usually is 3:1 and it affects patients in the fifth to sixth decade of life. [1] Frequently, it is associated with tobacco chewing and alcohol. [2]

The anterior tongue is a movable portion and extends from circumvallate papillae to the junction at the anterior floor of the mouth. It is divided into four regions: tip, lateral borders, and dorsal and ventral surfaces. Lymphatic drainage from the anterior tongue is into submental nodes, and the lateral borders drain into the submandibular and upper deep jugular nodes and communications which occur in the midline can lead to contralateral neck drainage.

The various treatment options for carcinoma of the anterior tongue are wide excision, hemiglossectomy, and primary excisions along with elective neck dissection. Here, we show a report of a case of carcinoma of the anterior tongue.


  Case Report Top


A 40-year-old male patient came to our department with the chief complaint of a nonhealing ulcer on tongue since 6 months. Initially, it was small and gradually it progresses to the present size (3 cm × 4 cm). On clinical examination, it was a ulcerative lesion on the left lateral border of anterior two-third of the tongue. The patient gave a history of gutkha chewing 4-5 packs per day since 6 years and occasionally he consumes alcohol also. Keeping in mind all factors, an incisional biopsy was done which came as a well-differentiated squamous cell carcinoma. Neck nodes were clinically negative. Wide surgical incision keeping at least 1 cm of safe margin was done under General Aneastesia (GA) [Figure 1] and the site was primarily closed.

Elective supraomohyoid neck dissection was also performed [Figure 2]. Excised specimen was sent for histopathology examination, and results show all margins are free. One neck node was turned out positive, so radiotherapy is also planned for the patient.
Figure 1: Incision marked

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Figure 2: Removal of neck nodes

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  Discussion Top


The tongue is the most common site for oral squamous cell carcinoma. [3] Squamous cell carcinomas of the anterior tongue are common in the Indian subcontinent and forms a group of major malignancies of head and neck. A thorough history and clinical examination and palpations are vital in diagnosis. [2]

Treatment depends on the size of lesion, location, and histopathological diagnosis as well as whether the neck nodes are positive. Squamous cell carcinoma of posterior one-third of tongue is more aggressive and is more prone to involve local tissues and is more prone for neck metastasis. [1]

Early cases can be treated with wide surgical excision but stage III/IV should be treated with wide surgical excision as well as ipsilateral neck dissection for positive nodes. [4] There is a controversy between whether to perform, elective neck dissection for clinically negative nodes. However, tumors having thickness >5 mm are prone for neck metastasis. The depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. [5] Michel J Vennes concluded that ipsilateral neck dissection should be done in all cases. [6] Hannal Vargha et al. suggested that younger patients need aggressive initial treatment and close surveillance for recurrence. [7]

Tumor thickness is an important predictive factor in the management of primary lesion as well as in the managements of neck nodes. A wait-and-see policy is only warranted for superficial lesions with a tumor thickness of <7 mm. [8] Elective neck dissection is usually the treatment of choice for stages I and II squamous cell carcinoma of the tongue. [3] Fukano et al. suggested that there is a discerning point at 5 mm of tumor depth at which cervical metastasis is probable. Electric neck therapy (surgery or irradiation) is strongly indicated for tumors exceeding 5 mm invasion. [9]


  Conclusion Top


Site, size, differentiation, and adequate safe margins, as well as neck node management, are the important factors in the treatment of squamous cell carcinoma of anterior two-third of the tongue; treatment should follow tumor-node-metastasis staging and guidelines. However, the decision regarding whether to perform elective neck dissection in negative neck patients requires large multicenter studies. Early detection of the primary lesion, whether but clinician or by the patient, and neck metastasis but the surgeons are vital in treatment as well as prognosis and survival rates.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Veeresh M, Kamal T, Ravikumar. Early squamous cell carcinoma of the anterior tongue; report of two cases. J Dent Med Sci 2014;13:1-4.  Back to cited text no. 1
    
2.
Liviu F, Johan L. Oral squamous cell carcinoma: Epidemiology, clinical presentation and treatment. J Cancer Ther 2012;3:263-8.  Back to cited text no. 2
    
3.
Randhawa T, Shameena P, Sudha S, Nair R. Squamous cell carcinoma of tongue in a 19-year-old female. Indian J Cancer 2008-Sep; 45:128-30.  Back to cited text no. 3
    
4.
Yuen AP, Wei WI, Wong YM, Tang KC. Elective neck dissection versus observation in the treatment of early oral tongue carcinoma. Head Neck 1997;19:583-8.  Back to cited text no. 4
    
5.
Veness MJ, Morgan GJ, Sathiyaseelan Y, Gebski V. Anterior tongue cancer and the incidence of cervical lymph node metastases with increasing tumour thickness: Should elective treatment to the neck be standard practice in all patients? ANZ J Surg 2005;75:101-5.  Back to cited text no. 5
    
6.
Carniol PJ, Fried MP. Head and neck carcinoma in patients under 40 years of age. Ann Otol Rhinol Laryngol 1982-Apr; 91 (2 Pt 1):152-5.  Back to cited text no. 6
    
7.
Freund HR. A Text Book - Principles of Head & Neck Surgery. Saint Louis, Mo: Mosby-Year Book, Inc., 2 nd ed. New York. 1998. p. 151-72.  Back to cited text no. 7
    
8.
Veness MJ, Morgan GJ, Sathiyaseelan Y, Gebski V. Anterior tongue cancer and the incidence of cervical lymph node metastases with increasing tumour thickness: Should elective treatment to the neck be standard practice in all patients? ANZ J Surg 2005;75:101-5.  Back to cited text no. 8
    
9.
Fukano H, Matsuura H, Hasegawa Y, Nakamura S. Depth of invasion as a predictive factor for c ervical lymph node metastasis in tongue carcinoma. Head Neck1997;19:205-10.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

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