Oral Cancer and Salivary Glands

Vocabulary practice flashcards covering oral squamous cell carcinomas, staging, surgical neck dissections, reconstructive flaps, salivary gland tumors, and congenital and infectious cervical neck swellings.

Oral Squamous Cell Carcinoma (Most Common Sites)

The most common site overall is the lateral border of the tongue, whereas the most common site in India is the gingivo-buccal sulcus.

p53 Mutation in Oral Cancer

The most common gene mutation identified in the pathogenesis of oral squamous cell carcinoma.

Keratin Pearls

A hallmark histopathological feature of well-differentiated squamous cell carcinoma (SCC), characterized by concentric circular nests of keratinised epithelial cells.

Leukoplakia

A premalignant white patch on the oral mucosa that cannot be rubbed off, carrying a $3\text{ to }5$ times increased risk of malignant transformation; diagnosis is confirmed by biopsy.

Erythroplakia

A premalignant red patch on the oral mucosa that confers a $6\text{ to }9$ times increased risk of cancer, with speckled erythroplakia being the most aggressive variant; confirmatory management requires biopsy.

Chronic Submucous Fibrosis

A premalignant condition precipitated by a hypersensitivity reaction to betel nuts, causing fibrous tissue deposition and trismus (inadequate mouth opening); treated with intra-lesional triamcinolone.

Plummer-Vinson Syndrome

A condition seen typically in perimenopausal women (also termed Paterson-Brown-Kelly syndrome) presenting with iron deficiency anemia (with koilonychia), angular stomatitis, glossitis, and post-cricoid or upper esophageal webs that elevate the risk for esophageal SCC and hypopharyngeal cancer.

Edge / Wedge Biopsy (Oral Lesions)

The standard diagnostic biopsy technique for oral cancer in which tissue is taken from the periphery of the lesion while avoiding the necrotic center, evaluating depth of invasion (DOI) as a critical prognostic parameter.

T1 Stage (Oral Cancer)

Tumor measuring $\le 2\,\text{cm}$ in greatest dimension with a depth of invasion (DOI) of $\le 5\,\text{mm}$.

T2 Stage (Oral Cancer)

Tumor measuring $\le 2\,\text{cm}$ with depth of invasion (DOI) of $5\text{ to }10\,\text{mm}$, OR a tumor measuring $2\text{ to }4\,\text{cm}$ with DOI $\le 10\,\text{mm}$.

T3 Stage (Oral Cancer)

Primary tumor measuring $> 4\,\text{cm}$ in size OR exhibiting a depth of invasion (DOI) $> 10\,\text{mm}$.

N3b Stage (Oral Cancer)

Metastatic cervical nodal involvement showing clinical or radiological extranodal extension ($\text{ENE}^{+}$, evidenced by matting or skin fixity of lymph nodes).

Commando Procedure

A combined surgical approach for advanced oral cancer comprising wide local excision with a $0.5\,\text{cm}$ surgical margin, segmental mandibular resection (if involved), and comprehensive neck dissection.

Modified Schoebinger's Incision

A specialized cervical incision configuration employed to provide optimal exposure during modified radical neck dissection (MRND).

Radical Neck Dissection (Crile)

Complete surgical removal of lymph node levels $1\text{ to }5$ along with three extra-lymphatic structures (sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve), the submandibular gland, and the tail of the parotid gland.

Modified Radical Neck Dissection (MRND)

Cervical lymphadenectomy of levels $1\text{ to }5$ that preserves at least one extra-lymphatic structure: MRND I spares the spinal accessory nerve; MRND II spares the spinal accessory nerve and internal jugular vein; MRND III (Functional ND) preserves all three structures.

Supraomohyoid Neck Dissection (SOHND)

A type of selective neck dissection encompassing lymph node levels I, II, and III; performed prophylactically in T1 and T2 oral cavity lesions.

Marginal Mandibular Nerve Injury

The most frequent nerve injury sustained during neck dissection or submandibular excision, causing drooping of the angle of the mouth; prevented by placing surgical incisions at least $2$ finger breadths beneath the inferior border of the mandible.

Deltopectoral Flap

A classic regional, medially-based fasciocutaneous chest wall flap based on the internal mammary perforators used for head and neck reconstruction.

Radial Artery Forearm Flap

A microvascular free flap based on the radial artery; mandates a preoperative modified Allen's test to verify adequate collateral circulation via the ulnar artery and deep palmar arch.

Pectoralis Major Myocutaneous (PMMC) Flap

The most widely utilized regional flap by head and neck reconstructive surgeons, pedicled on the pectoral branch of the thoracoacromial artery.

Free Fibular Flap

A composite vascularized bone and soft-tissue free flap harvested from the lower extremity, primarily indicated for bony mandibular reconstruction.

Mucus Retention Cyst

A benign cystic dilation of a minor salivary gland duct occurring on the lip or buccal mucosa, definitively managed by surgical excision.

Ranula

A mucus extravasation cyst of the sublingual salivary gland situated in the floor of the mouth; characteristically fluctuant and brilliantly transilluminant, definitively managed by combined excision of the cyst and the sublingual gland, or marsupialization.

Plunging Ranula

A mucus cyst arising from the sublingual and submandibular glands that herniates below the mylohyoid muscle into the neck; managed by intraoral excision of the swelling alongside neck swelling aspiration.

Recurrent Parotitis in Childhood

A condition occurring in children aged $3\text{ to }6\,\text{years}$ manifesting as recurrent parotid swelling aggravated by chewing; demonstrates a classic 'snowstorm appearance' on imaging and is managed with prolonged antibiotics and ductal endoscopic washouts.

Sialolithiasis

Salivary calculi composed mainly of calcium phosphate, occurring predominantly in the submandibular gland due to viscous secretions and antigravity duct drainage; non-contrast CT (NCCT) is the investigation of choice, and treatment proceeds from endoscopic removal to duct slitting and gland excision.

Pleomorphic Adenoma

The most common salivary gland neoplasm; a slow-growing, benign tumor commonly arising in the superficial lobe of the parotid gland, demonstrating a triphasic microscopic appearance (epithelial ductal cells, myoepithelial cells, and stroma) and treated with superficial parotidectomy.

Warthin's Tumor

The second most common benign parotid neoplasm (adenolymphoma), demonstrating male predominance and the highest propensity for bilateral presentation; histologically composed of two layers of mitochondria-rich oncocytic cells embedded in lymphoid stroma.

Adenoid Cystic Carcinoma

The second most common malignant salivary neoplasm, characterized by a classic 'Swiss cheese' (cribriform) histopathological pattern and a high rate of perineural invasion (PNI), resulting in painful lesions and late recurrences.

Lazy S Incision

The standard surgical incision (modified Blair's incision) placed preauricularly and extended below the ear lobule into the neck to afford access for parotidectomy.

Frey's Syndrome

A complication of parotidectomy marked by gustatory sweating, caused by misdirected regeneration of post-ganglionic parasympathetic fibres of the auriculotemporal nerve into cutaneous sweat glands; definitive medical management includes botulinum toxin, and the surgical treatment of choice is tympanic neurectomy.

Starch Iodine Test

A diagnostic topical test (Minor's test) used to confirm Frey's syndrome by demonstrating dark purple-black discoloration upon sweating provoked by gustatory stimuli.

Bimanual Palpation (Submandibular Triangle)

A clinical examination technique where fingers are placed simultaneously in the floor of the mouth and externally over the neck; an enlarged submandibular salivary gland is palpable, whereas submandibular lymph nodes are typically not bimanually palpable.

Dermoid Cyst (Head and Neck)

A developmental cystic mass formed along embryonic fusion lines, classically situated in the post-auricular region or outer canthus; requires preoperative cross-sectional imaging to exclude intracranial extension prior to surgical excision.

Tubercular Cold Abscess

A collar-stud abscess of tubercular cervical lymphadenitis presenting without systemic or local signs of acute inflammation; managed by non-dependent (anti-gravity) needle aspiration to prevent cutaneous sinus or fistula formation.