This multicenter study objectively evaluated postoperative speech and masticatory and swallowing functions in patients with cancer of the tongue/floor of the mouth who had undergone ablative surgery and reconstruction with a pedicled or vascularized free flap. A total of 150 patients from 13 Japanese institutions were enrolled and subsequently classified according to the site of resection into the following three groups: lateral (n = 109); anterior (n = 20); and combined (n = 21). The lateral group was further divided into three subgroups, and the anterior group into two subgroups, according to the size of resection. Reconstruction was accomplished by radial forearm flap (RFF) in 86 patients, rectus abdominis myocutaneous flap (RAMCF) in 29, pectoralis major myocutaneous flap (PMMCF) in 17, cervical island flap (CIF) in 7, anterior lateral thigh flap (ALTF) in 6, and others in 5. Postoperative function was evaluated objectively using speech and conversational intelligibility tests, a color-developing chewing gum test and pressure-sensitive sheets for mastication, and a water-swallowing test for swallowing.
The results showed that, in the L group, the size of resection influenced speech to some degree, but not masticatory function. Aspiration during water-deglutition could be observed in some patients who had undergone resection of a relatively small part of the tongue. Among patients who had undergone partial glossectomy, RFF or CIF showed better results than PMMCF in the chewing gum test. Relative merits of RAMCF or RFF were not clear in subjects with half resection of the anterior two-thirds of the tongue. Subjects with anterior lateral thigh flap showed better function in the hemiglossectomized group than those with other flaps.
In group A, resection size had little impact on speech function, but affected masticatory and swallowing function. RFF was more useful than RAMCF for maintaining swallowing function when resection was limited within one-third of the anterior part of the tongue.
Group C showed the lowest speech and masticatory functions. Regarding swallowing function, group C had better results than group A in the water-swallowing test, although the rate of aspiration was higher than that in the other groups. Donor sites had no effect on functional results.
These results suggest that we should aim to achieve higher functional level in patients with cancer of the tongue/floor of the mouth, refine suturing techniques for flaps, and clarify the usefulness of nerve preservation/reconstruction and elevation of the hyoid bone to increase the effectiveness of rehabilitation in the future.

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Squamous cell carcinoma of the tongue sometimes develops into regional lymph node metastasis after ablative surgery. Delayed cervical lymph node metastasis is one of the prognostic factors. The relationship between delayed cervical lymph node metastasis and clinico-pathological prognostic factors was investigated in N0 cases of squamous cell carcinoma of the tongue. Sixty-five patients (T1: 28 cases, T2: 35 cases, T3: 2 cases) were enrolled between January 1991 and December 2006 in this study. The mean age of the patients was 60.6 years. All patients received partial glossectomy alone. The 10-year cumulative overall survival rate was 84.6%. The 10-year cumulative local recurrence rate was 16.7%. We also investigated the delayed cervical lymph node metastasis in 58 cases with no local recurrence and delayed cervical lymph node metastasis that developed in 15 cases, and the cumulative delayed cervical lymph node metastasis rate was 27.0%. The metastasis rate was significantly higher in the endophytic clinical type than the other types. Delayed cervical lymph node metastasis occurred in 42.9% in YK-4C and 48.1% in YK-4D and the metastasis rate was significantly higher than the other types of mode of invasion. Delayed cervical lymph node metastasis developed in 53.3% of the cases with pathological lymphatic invasion. These results suggest that the risk factors for delayed neck metastasis of N0 tongue cancers are endophytic clinical type, YK-4C and YK-4D type of mode of invasion and the presence of lymphatic invasion.

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Glomangiomyoma is a subtype of glomus tumors, which usually occur in the subungual layer. Such tumors localized to the oral cavity are very rare, and are most commonly in the center of the upper lip. The clinical symptoms are solitary swelling without pain, and excision of the tumor is recommended for treatment. Recurrence is rare and the prognosis is good.
A 61-year-old man was referred to the Department of Oral Surgery at our institution in March 2012 complaining of swelling of his upper lip. He had noticed the swelling two months earlier and had been left untreated. Intraoral examination revealed a marked small swelling without inflammatory symptoms in the center of the upper lip. The lesion was a well-defined submucosal mass. The size of the lesion was 5 mm and also showed mobility. One week later the lesion expanded rapidly. We performed imaging examination, including magnetic resonance imaging (MRI) and ultrasonography (US). The lesion had developed in the submucosal layer of the upper lip and measured approximately 10 mm in size. A minor salivary gland tumor was suspected and excisional biopsy was performed. The mass was well circumscribed, was excised completely, and the surgical site was closed. The removed specimen was placed in 10% formalin and submitted for histological examination. Histological and immunohistochemical studies were performed, and a diagnosis of glomangiomyoma was made.

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