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Aseem Mishra

Tata Memorial Hospital, Head and Neck Services, Surgical Oncology, Post-Doc

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Vrije Universiteit Brussel

Joachim Sturmberg

Monash University

University of Cambridge

Aslı SUNER (KARAKÜLAH)

Ege University

University of Hertfordshire

University of Malaya, Malaysia

Nima M.NEJAT (moharamnejad)

Istanbul Aydin University

Maurizio Vivarelli

Università degli Studi di Torino

Salamatu J Fada

Bangor University

Universidad Nacional Mayor de San Marcos

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Papers by Aseem Mishra

Comparative study of functional outcomes following surgical treatment of early tongue cancer

Head & Neck, 2021

Speech and swallowing are important outcomes following resection in early tongue cancers.

Comparison of tumor volume, thickness, and T classification as predictors of outcomes in surgically treated squamous cell carcinoma of the oral tongue

Head & neck, Jan 7, 2018

As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed... more As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed together with unfavorable, deeply infiltrating lesions in the same classification. This is a retrospective study of 588 patients with treatment-naive oral tongue cancers. Binary logistic regression was used to identify predictors of nodal metastasis and extracapsular spread (ECS) using tumor volume and thickness as separate models. The C-index was generated to quantify predictive accuracy of T classification, thickness, and tumor volume for survival. Compared to T classification, tumor volume and thickness were better predictors of nodal metastasis and ECS. Predictive accuracy for disease-free survival (DFS) and overall survival (OS) given by C-index was equal and better for thickness (0.60 and 0.69) and tumor volume (0.61 and 0.69) as compared to T classification (0.59 and 0.64, respectively). For early-stage T1 to T2 oral tongue cancer, thickness is a better predictor of nodal metasta...

Prospective study of the pattern of lymphatic metastasis in relation to the submandibular gland in patients with carcinoma of the oral cavity

Head & Neck, 2016

The submandibular gland is responsible for 70% to 90% of unstimulated saliva production. Its exci... more The submandibular gland is responsible for 70% to 90% of unstimulated saliva production. Its excision causes a decrease in basal salivary flow resulting in increased symptoms of subjective xerostomia and decreased quality of life. In this study, we have tried to assess the pattern of nodal metastasis in relation to the submandibular gland. With this study, we have tried to find out whether submandibular gland preservation is a viable option in patients with carcinoma of the oral cavity. This was a prospective study conducted in a tertiary care cancer center. The fibrofatty tissue surrounding the submandibular gland was divided into 6 parts depending upon its location with the submandibular gland. All these 6 parts along with the submandibular gland were separately sent for histopathological analysis. Metastasis pattern in level Ib region was noted. The study included 137 patients with carcinoma of the oral cavity who underwent neck dissections. Eighty-five patients had clinic-radiologically N0 neck, 52 patients had cN+ (clinically node positive) neck. Level Ib was involved in 8.2% of the cases with cN0 (clinically node negative neck). In patients with cN+ neck, level Ib metastasis was seen in 40% of the cases. Metastasis in N0 necks in the area deep to the submandibular gland was seen in only 1 case (9% of all pathologically node-positive patients) with cN0 neck. This was the only case in which submandibular gland mobilization would have been required to take out the metastatic node. Even in cases with N+ neck, deep metastasis was seen in 4 cases only (14.8%). None of them had a primary tumor in the tongue. Therefore, there is a possibility of preserving the submandibular gland in cases of carcinoma of the tongue. Involvement of level Ib in early tongue cancers is not very common and direct metastases to the submandibular glands are rare. Even when metastasis is present in level Ib, it can be excised without affecting the submandibular gland. In early tongue lesions, submandibular gland mobilization for dissection at level Ib is not required as no metastases deep to the submandibular glands were seen in these patients. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

A review of Indian literature for association of smokeless tobacco with malignant and premalignant diseases of head and neck region

Indian Journal of Cancer, 2014

In India, about 60% of tobacco users use smokeless tobacco (ST) alone. Head and neck squamous cel... more In India, about 60% of tobacco users use smokeless tobacco (ST) alone. Head and neck squamous cell carcinoma is one of the most common cancers in India. International Agency for Research on Cancer (IARC) monograph (Vol 89) found a significant association between ST use and oral cancer. However, only a few articles from India were included in this monograph. To overcome this lacuna, we have reviewed the articles published from India investigating the association between ST use and malignant and premalignant diseases of head and neck region. Data collection has been performed by computer-aided search of the MedLine and PubMed databases using different combinations of the key words. For malignant lesions, only cohort and case control studies were considered for review. For premalignant lesions and dental diseases other than case control studies, some cross-sectional studies have also been reviewed. Studies found a significant association between ST use and cancer of the oral cavity. The association was stronger for the buccal mucosa compared to tongue and for females compared to males. Significant association noted between cancer of the hypopharynx and oropharynx with ST use but no definitive association noted for cancer of the larynx and nasopharynx. Some dental disease and oral premalignant conditions were also associated with ST use. Indian studies suggest ST use is strongly associated with cancer of the oral cavity, oropharynx and hypopharynx.

A review on harmful effects of pan masala

Indian Journal of Cancer, 2015

Pan masala (PM) is a mixture of areca nut with slaked lime, catechu and other flavoring agents. I... more Pan masala (PM) is a mixture of areca nut with slaked lime, catechu and other flavoring agents. It is widely available and used by all the sections of the Indian society. It is genotoxic as it increases sister chromatin exchange and chromatin aberrations. Among humans, it is a leading cause of oral submucous fibrosis that often progresses to oral cancer. Among experimental animals, it leads to neoplastic lesions in lung, liver and stomach. It is hepatotoxic leading to increased level of enzymes, deranged carbohydrate and lipid metabolism. It is harmful to kidneys and testes leading to increased creatinine and sperm deformities respectively. PM is a very harmful substance affecting almost all organ systems, and there is immediate need for a national policy on complete ban on the production, storage, sale and marketing of PM.

Role of Robotics in Non-oropharyngeal Head and Neck Tumours

Indian Journal of Surgical Oncology, 2022

Transoral robotic surgery has been gaining widespread acceptance for the treatment of oropharynge... more Transoral robotic surgery has been gaining widespread acceptance for the treatment of oropharyngeal malignancies. It has shown tremendous growth in the field of non-oropharyngeal malignancies like thyroidectomy, neck dissection, and parapharyngeal tumours. Many studies have aimed at studying the safety and efficacy of the technique. The literature is abundant for procedures and treatment protocols for oropharyngeal malignancy; however, there is paucity on its usability in non-oropharyngeal malignancy. We aim to review the literature to analyse the usability of robotics in non-oropharyngeal tumours and study the evolution and future applications of robotics in head and neck cancer. A thorough literature search using keywords “Transoral robotic surgery”, “TORS”, “ Robotics in Head and Neck”, “ Robot-assisted Neck Dissection”, “ Robotic Thyroidectomy”, “ Robotic Laryngectomy”, “ Robotics in salivary gland disease”, “ Parapharyngeal space”, “Systematic review”, and “Meta-analysis” was done. The articles were reviewed individually by each author for a dedicated sub-heading. A narrative review was formulated under the subheadings—thyroid surgery, salivary gland, neck dissection, parapharyngeal space, and laryngectomy. The role of robotics has expanded with the advances in technology. Non-oropharyngeal head and neck disease can be approached using robotics. Careful patient selection provides a significant advantage of function and cosmesis and helps in avoiding inadvertent complications. With our growing experience, we might see a surge in robot-assisted head and neck surgery.

Bilateral Tunnelized FAMM Islanded Flap for Reconstruction of Composite Defect of Tongue and Floor of Mouth: A Case Report

Journal of Maxillofacial and Oral Surgery, 2021

The work of Massarelli et al. is well known for popularizing t-FAMMIF, however to the best of our... more The work of Massarelli et al. is well known for popularizing t-FAMMIF, however to the best of our knowledge bilateral flap has never been harvested and inset together to reconstruct a composite defect. Larger unilateral flaps have been reported in literature but to harvest such a flap in patients of S.E Asian region would entail high propensity for trismus in the post op period as they have tendency for submucosal fibrosis owing to their guthka (chewing tobacco) chewing habits. Oral submucous fibrosis is contra-indication for this flap; however, some of our patients despite being chronic abusers of guthka do not have clinical presentation of OSMF and if the defect post ablation is appropriate are chosen to be candidates for reconstruction with the flap. In this select population harvesting larger flaps can potentially lead to trismus, a fact highlighted in the paper.

Optimum surgical margins in squamous cell carcinoma of the oral tongue: Is the current definition adequate?

Oral Oncology, 2020

OBJECTIVES To evaluate the impact of progressively increasing margin distances on locoregional re... more OBJECTIVES To evaluate the impact of progressively increasing margin distances on locoregional recurrence-free survival (LFRS) and determine an optimum margin distance for tongue cancers. METHODS We retrospectively reviewed the records of patients with squamous carcinoma of oral tongue, surgically treated between January 2012 and December 2013. The patients were divided based on ROC derived optimal distance and differences in LRFS per millimeter: margin distances with no significant difference in LRFS starting from 0 mm onwards (Group-I), from upper limit of Group-I to ROC cut-off (Group-II), and all values above it (Group-III). Group-II and III were matched for clinicopathologic factors and type of adjuvant therapy received. RESULTS 451 patients had a median LRFS of 29.4 months that included 32.1% of Stage I/II and 51.7% of Stage III/IV. Group-I consisted of 0--2.0 mm (2.0-2.1 mm (p-0.029)), Group-II form 2.1 to 7.5 (7.5-7.6 mm (p-0.042)) and Group-III were ≥ 7.6 mm. In the matched group, each millimeter increase in margin provided a 3.67 months survival advantage from 2.1 mm to 7.5 mm while a substantial advantage of 15 months was seen from 7.5 to 7.6 mm. No significant advantage was gained in LRFS when the margin was increased by a millimeter from the cut-off value (p-0.602). Among the patients that were not prescribed any adjuvant therapy, a significantly better LRFS was observed in Group III than Group II (HR-3.01, p-value = 0.002). CONCLUSION Based on these results, adequacy of surgical margins should be re-considered for oral tongue cancers.

Pedicled Latissimus Dorsi Myocutaneous Flap-an Effective Reconstructive Option for Extensive Buccal Cancer Resection in Resource Constrained and Salvage Settings

Indian Journal of Surgical Oncology, 2020

Free flaps are the gold standard for reconstruction of extensive buccal cancer resections. Howeve... more Free flaps are the gold standard for reconstruction of extensive buccal cancer resections. However, salvage surgeries in previously operated and radiated necks, cost, increased operating time, and patient co-morbidities limit their routine use in high volume and resource-constrained settings. Pectoralis major myocutaneous (PMMC) flap is the mainstay of reconstruction of large buccal defects. However, reconstruction becomes a challenge during salvage of recurrences where PMMC has been utilized in previous reconstruction and in female patients where PMMC harvest results in major donor site morbidity. A retrospective analysis of clinical data of 13 consecutive patients (eight male and five female) with through and through buccal cancer resection defects reconstructed using pedicled latissimus dorsi (LD) flap from July 2018 to September 2019 was performed. The indications of using an LD flap were salvage surgeries for recurrences where PMMC was used in earlier reconstruction, medical co-morbidities, vessel depleted necks, and financial constraints precluding use of free flaps. The mean follow-up period was 9.84 months. The mean operating time post-resection was 2 h and 26 min. The mean hospital stay was 12.61 days. All patients could be decannulated successfully (mean duration 9.69 days) and 12 could be weaned off feeding tube. None of the patients had any major flap related or donor site complications. Pedicled LD flap has a limited but an effective reconstructive role for extensive buccal cancer ablation as an alternative to free flaps and PMMC in salvage and resource-constrained situations.

Trends of Oral Cancer with Regard to Age, Gender, and Subsite Over 16 Years at a Tertiary Cancer Center in India

Indian Journal of Medical and Paediatric Oncology, 2018

Introduction: Oral cancers are among the most common cancers in the Indian subcontinent and tobac... more Introduction: Oral cancers are among the most common cancers in the Indian subcontinent and tobacco is the most common implicated etiologic agent for these cancers. Over last two decades, significant changes have occurred in the lifestyle of people in the subcontinent. Antitobacco legislations have made developed and awareness about the harmful effects of tobacco and related products have increased. We hypothesized that this would lead to change in tobacco use pattern and hence impact the trends of oral cancer in India. Methodology: We analyzed the hospital records of patients having buccal mucosa and tongue cancers at a tertiary care cancer center. We noted the trends of patients presenting with these cancers 4 yearly, over a period of 16 years and in this way tried to assess the impact of legislation and awareness activities upon cancer incidence and trends. Results:: This study has shown that the number of patients presenting with tongue and buccal mucosa cancers has not decrease...

Emergency department visits by head-and-neck cancer patients

Indian Journal of Palliative Care, 2019

Aim: This study was conducted to assess the disease status of head-and-neck cancer patients visit... more Aim: This study was conducted to assess the disease status of head-and-neck cancer patients visiting the emergency department (ED) and their reason for presentation. We wanted to analyze if these visits could be avoided by incorporating any changes in our clinical practice. Methods: This was a retrospective analysis of head-and-neck cancer patients attending the ED at a tertiary care cancer center in 2017. Clinical details were noted from the electronic medical records, and descriptive statistics was calculated. The analysis was performed using SPSS version 21 software. Results: Three hundred and thirty-nine head-and-neck cancer patients attended the ED. Of these, 80.2% were males and 48.1% of patients had oral cavity cancers. About 37.2% required palliative care treatment. Nearly, 47.2% of patients presented during their initial evaluation period. About 22.7% required hospital admission and only 14.7% required any sort of emergency intervention. Conclusion: Majority of visits to ED could have been avoided with better counseling of the patients and their attendants.

Frozen section is not cost beneficial for the assessment of margins in oral cancer

Indian Journal of Cancer, 2019

BACKGROUND Routine use of frozen section (FS) is a costly procedure and sparsely available in res... more BACKGROUND Routine use of frozen section (FS) is a costly procedure and sparsely available in resource poor countries. A proper cost benefit analysis may help to reduce its routine use and would empower surgeons to perform oral cancer surgeries without having FS facility. FS is performed to identify microscopic spread beyond gross disease that cannot be assessed clinically. OBJECTIVE Our primary aim was to determine the cost benefit analysis of FS in the assessment of margins in oral cavity squamous cell carcinoma (OSCC). MATERIALS AND METHODS Retrospective study of prospectively collected data of 1311 consecutive patients who were operated between January 2012 and October 2013. The gross and microscopic margin status of each patient was extracted from the patient's chart. The cost estimates were performed to calculate the financial burden of FS as well as expenses incurred on adjuvant treatment resulting from inadequate margins. RESULT Microscopic spread changed the gross margin status in 5.2% (65/1237) patients. Of this entire cohort of 1237 patients, FS helped 29 (2.3%) patients to achieve tumor free margin, and it changed the adjuvant treatment plan in 9 (0.7%) patients. The cost of FS for each patient was INR 11052. The cost-benefit ratio of FS was 12:1. Gross examination alone could have identified majority of the inadequate margins. CONCLUSION Frozen section for assessment of margin status bears poor cost-benefit ratio. Meticulous gross examination of the entire surgical specimen is sufficient to identify majority of inadequate margins.

Impact of age on elderly patients with oral cancer

European Archives of Oto-Rhino-Laryngology, 2018

Introduction In this study we have tried to analyze the impact of age on various clinico-patholog... more Introduction In this study we have tried to analyze the impact of age on various clinico-pathological parameters, treatment completion and subsequent survival in older patients. Materials and methods This is a retrospective analysis of 140 elderly (> 65 years) patients of oral cancer operated between January 2012 and December 2013. The patients were divided into two groups based upon their age that ≤ 70 years and > 70 years.Association of distribution of various clinico-pathological factors between different groups was assessed by using Chi-square test. Survival analysis was done using Kaplan Meir analysis. Univariate and multivariate analysis were performed. Results The two groups had similar distribution of various clinico-pathological factors. Disease free survival for the group ≤ 70 and > 70 years was 37.6 months and 36.4 months (p < 0.594). 13.5% and 7.8% patients > 70 years and ≤ 70 years were either advised or received sub-optimal adjuvant therapy (p < 0.002). Conclusion There is no difference distribution of various clinico-pathological factors and survival in patients of oral cancer ≤ 70 and > 70 years of age. Age did not affect survival. Majority of patients could complete the adjuvant therapy advised. Still, significantly more number of patients > 70 years could not receive/complete appropriate adjuvant therapy. Thus treatment needs to be tailored keeping in mind the individual's performance status and the co-morbidities.

Oral squamous cell carcinoma associated with oral submucous fibrosis have better oncologic outcome than those without

Oral surgery, oral medicine, oral pathology and oral radiology, Jan 4, 2017

Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with the use of are... more Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with the use of areca nut, and is mainly seen in the parts of Southeast Asia and the Indian subcontinent. We hypothesized that oral cancers occurring in presence of OSMF are clinicopathologically a distinct entity. We analyzed 289 treatment naïve patients of oral cancer. They were followed up for a median of 44 months. Association of presence of OSMF with other histopathological factors was done using the χ(2) test. Kaplan-Meier analysis was used for survival analysis. Oral squamous cell carcinoma along with OSMF was seen more often in younger patients (P < .001) and males (P < .007), and had a lower T-stage (P < .002) and N-stage (P < .000). These were thinner (P < .002), less infiltrative (P < .04) tumors and required adjuvant therapy less frequently (P < .017). The mean disease specific survival, overall for those with and without OSMF was 58.8 and 48.6 months (P < .002), and spe...

Intraoperative gross examination vs frozen section for achievement of adequate margin in oral cancer surgery

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2017

Introduction:Surgical margin status is one of the important prognostic factors in oral squamous c... more Introduction:Surgical margin status is one of the important prognostic factors in oral squamous cell carcinoma.The primary aim of the surgeon is to achieve a microscopically complete surgical resection during initial surgery.As there are no definite guidelines,few surgeons use Frozen section(FS) for margin assessment while others use Gross examination(GE). Materials and Methods:This is a retrospective analysis of prospectively collected data from Electronic Medical Records of 435 oral cavity cancer patients.As per the operating surgeon's preference, margin assessment was done using GE in 239(54.94%)specimens and FS was used in 196(45.05%) specimens.Surgery was the primary modality of treatment for all the patients followed by adjuvant therapy. Results:Incidence of close/positive margin was seen in 6.63% patients in FS group and in 6.69% patients in GE group(p-0.855).The sensitivity and specificity of frozen section were 45.45% and 98.8%, while for GE was 61.9% and 88.32% respectively.We found no survival benefit when FS was used for margin assessment(p-value-DFS:0.469,OS:0.325).Incidence of inadequate margins was similar in both the groups (p-0.608) even in patients with some form of previous treatment Conclusion:We propose the judicious use of frozen section rather than its routine use for margin assessment.The study proves that GE is an oncologic safe alternative to FS.

Perineural Invasion Independent Prognostic Factors in Patients with Gastric Cancer Undergoing Curative Resection

Asian Pacific Journal of Cancer Prevention, 2012

Objective: The prognostic significance of perineural invasion (PNI) in gastric cancer has been pr... more Objective: The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated but not clearly clarified. The objective of our study was to investigate the role of PNI as prognostic factor in patients undergoing curative surgical resection and without distant metastasis in comparison with other clinicopathological factors. Methods: Between 2001 and 2010, 287 cases of gastric adenocarcinoma underwent radical gastrectomy recorded in hospital based registries. PNI was assessed as positive when cancer cells were seen in the perinerium or neural fascicles intramurally. Categorical and continuous variables were summarized using descriptive statistics and compared using chi-square and Mann-Whitney U tests, respectively. Cancer related survival rates were estimated by the Kaplan-Meier method. Results: PNI was positive in 211 of 287 cancers (73%), with a positive relation to lymph node metastases and advanced stage (p=0.0001, p=0.0001, respectively), mural invasion, and lymphatic and blood vessel invasion (p=0.0001, p=0.0001, respectively). The median survival of the PNI positive patients was significantly shorter than that of their PNI negative counterparts (24.1 versus 38.2 months, p=0.008). In the multivariate analysis, we detected PNI was an independent prognostic factor (p=0.025, HR=1.21, 95% CL 1.08-2.3) along with classical clinicopathological variables such as lymph node involvement (p=0.001), pT stage (p=0.03), and LVI (p=0.017), but not age, gender, tumour localization, stage, histologic type, and surgery procedure. Conclusions: PNI positivity in gastric cancers was related mural invasion, lymph node involvement, advanced stage and lymphatic and venous blood vessels. The presence of PNI appeared as an independent prognostic factor on survival on multivariate analysis, not influenced by tumor stage, lymph node metastases and other classical factors.

Acute toxicities of adjuvant treatment in patients of oral squamous cell carcinoma with and without submucous fibrosis: A retrospective audit

Journal of Cancer Research and Therapeutics, 2016

To assess the severity of acute toxicities of postoperative adjuvant therapy on oral squamous cel... more To assess the severity of acute toxicities of postoperative adjuvant therapy on oral squamous cell carcinoma (OSCC) patients with and without submucous fibrosis (SMF). The study population comprised treatment naïve OSCC patients who underwent curative intent surgical resection from June 2010 to April 2011 followed by adjuvant treatment. Patients whose treatment details including toxicity profile were available were included in the study. One-hundred nine patients met the inclusion criteria of whom 36 had associated SMF and 73 no SMF. Overall, 35 patients received chemotherapy (CT) with radiotherapy (RT) and the rest only RT. Forty-two patients had centralized and 67 lateralized lesions. All patients with centralized lesions and 3 with lateralized lesion received radiation to bilateral face and neck. All others received ipsilateral radiation. The severity of mucositis, xerostomia, and skin toxicity (as per radiation therapy oncology group scale of acute toxicity) was compared between the SMF and non-SMF groups and patients with centralized and lateralized lesions. CT in addition to RT did not add significant to the assessed toxicities. Severe mucositis as well as treatment breaks were more in SMF group as compared to non-SMF group (P = 0.001 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 respectively). Severe mucositis and xerostomia were more in centralized than in lateralized lesions (P = 0.002 and 0.00 respectively). In subgroups of lateralized as well as centralized lesions, severe mucositis was more common in SMF patients than those without SMF (P = 0.01 and 0.02 respectively). OSCC patients with SMF have worse toxicity with adjuvant therapy and require good supportive care.

Prevalence of Functional Problems After Oral Cavity Malignancy Treatment at a Tertiary Center: Utilizing PSS HN (Performance Status Scale for Head and Neck) Scale

Journal of Maxillofacial and Oral Surgery, 2015

Background Oral cancer is the most common type of cancer occurring in India and it is equally imp... more Background Oral cancer is the most common type of cancer occurring in India and it is equally important to assess morbidities after treatment for optimal utilization of resources. Utilizing PSS HN we try to identify the patient population who are severely impaired and need aggressive rehabilitation. Method and Material The PSSHN questionnaire was administered by the treating physician to 100 consecutive oral cancer patients who completed their index treatment at least 6 months prior to accrual. Functional morbidities with score B50 were considered as significant. Results Prevalence of functional deficit of eating in public; deficit of understandability of speech and deficit of normalcy of diet were 28, 13 and 38 % respectively. Conclusion Type of resection either segmental mandibulectomy or major glossectomy, had most significant impact on concerned functional deficits and surgeries involving these defects should be carefully planned to involve free flap reconstruction and proper postoperative rehabilitation.

Palatal Cyst: An Unusual Case Report

International Journal of Otolaryngology and Head & Neck Surgery, 2013

Cyst is a fluid accumulated in a cavity lined by epithelium. Cyst over the hard palate is very in... more Cyst is a fluid accumulated in a cavity lined by epithelium. Cyst over the hard palate is very infrequent. Cyst is commonly seen along nasoalveolar duct or midline palatal cyst which are congenital. Only few cases of palatine cysts have been reported in literature. We present here a case of 21 years old male with a cystic lesion over the hard palate since 2 years.

Myoepithelioma of Tongue

International Journal of Otolaryngology and Head & Neck Surgery, 2013

Myoepithelioma is a rare neoplasm of the salivary glands, generally occurring in the parotid glan... more Myoepithelioma is a rare neoplasm of the salivary glands, generally occurring in the parotid gland and less often in the minor accessory salivary gland of the oral cavity. The histological appearance includes solid, myxoid and reticular growth patterns. Vimentin and S-100 protein are very sensitive but non-specific immunohistochemical markers of neoplastic myoepithelium. Conservative surgery is the treatment of choice. A case of myoepithelioma of the minor salivary gland of tongue is described, focusing on clinical behaviour, histopathological and immunohistochemical features.

Comparative study of functional outcomes following surgical treatment of early tongue cancer

Head & Neck, 2021

Speech and swallowing are important outcomes following resection in early tongue cancers.

Comparison of tumor volume, thickness, and T classification as predictors of outcomes in surgically treated squamous cell carcinoma of the oral tongue

Head & neck, Jan 7, 2018

As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed... more As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed together with unfavorable, deeply infiltrating lesions in the same classification. This is a retrospective study of 588 patients with treatment-naive oral tongue cancers. Binary logistic regression was used to identify predictors of nodal metastasis and extracapsular spread (ECS) using tumor volume and thickness as separate models. The C-index was generated to quantify predictive accuracy of T classification, thickness, and tumor volume for survival. Compared to T classification, tumor volume and thickness were better predictors of nodal metastasis and ECS. Predictive accuracy for disease-free survival (DFS) and overall survival (OS) given by C-index was equal and better for thickness (0.60 and 0.69) and tumor volume (0.61 and 0.69) as compared to T classification (0.59 and 0.64, respectively). For early-stage T1 to T2 oral tongue cancer, thickness is a better predictor of nodal metasta...

Prospective study of the pattern of lymphatic metastasis in relation to the submandibular gland in patients with carcinoma of the oral cavity

Head & Neck, 2016

The submandibular gland is responsible for 70% to 90% of unstimulated saliva production. Its exci... more The submandibular gland is responsible for 70% to 90% of unstimulated saliva production. Its excision causes a decrease in basal salivary flow resulting in increased symptoms of subjective xerostomia and decreased quality of life. In this study, we have tried to assess the pattern of nodal metastasis in relation to the submandibular gland. With this study, we have tried to find out whether submandibular gland preservation is a viable option in patients with carcinoma of the oral cavity. This was a prospective study conducted in a tertiary care cancer center. The fibrofatty tissue surrounding the submandibular gland was divided into 6 parts depending upon its location with the submandibular gland. All these 6 parts along with the submandibular gland were separately sent for histopathological analysis. Metastasis pattern in level Ib region was noted. The study included 137 patients with carcinoma of the oral cavity who underwent neck dissections. Eighty-five patients had clinic-radiologically N0 neck, 52 patients had cN+ (clinically node positive) neck. Level Ib was involved in 8.2% of the cases with cN0 (clinically node negative neck). In patients with cN+ neck, level Ib metastasis was seen in 40% of the cases. Metastasis in N0 necks in the area deep to the submandibular gland was seen in only 1 case (9% of all pathologically node-positive patients) with cN0 neck. This was the only case in which submandibular gland mobilization would have been required to take out the metastatic node. Even in cases with N+ neck, deep metastasis was seen in 4 cases only (14.8%). None of them had a primary tumor in the tongue. Therefore, there is a possibility of preserving the submandibular gland in cases of carcinoma of the tongue. Involvement of level Ib in early tongue cancers is not very common and direct metastases to the submandibular glands are rare. Even when metastasis is present in level Ib, it can be excised without affecting the submandibular gland. In early tongue lesions, submandibular gland mobilization for dissection at level Ib is not required as no metastases deep to the submandibular glands were seen in these patients. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

A review of Indian literature for association of smokeless tobacco with malignant and premalignant diseases of head and neck region

Indian Journal of Cancer, 2014

In India, about 60% of tobacco users use smokeless tobacco (ST) alone. Head and neck squamous cel... more In India, about 60% of tobacco users use smokeless tobacco (ST) alone. Head and neck squamous cell carcinoma is one of the most common cancers in India. International Agency for Research on Cancer (IARC) monograph (Vol 89) found a significant association between ST use and oral cancer. However, only a few articles from India were included in this monograph. To overcome this lacuna, we have reviewed the articles published from India investigating the association between ST use and malignant and premalignant diseases of head and neck region. Data collection has been performed by computer-aided search of the MedLine and PubMed databases using different combinations of the key words. For malignant lesions, only cohort and case control studies were considered for review. For premalignant lesions and dental diseases other than case control studies, some cross-sectional studies have also been reviewed. Studies found a significant association between ST use and cancer of the oral cavity. The association was stronger for the buccal mucosa compared to tongue and for females compared to males. Significant association noted between cancer of the hypopharynx and oropharynx with ST use but no definitive association noted for cancer of the larynx and nasopharynx. Some dental disease and oral premalignant conditions were also associated with ST use. Indian studies suggest ST use is strongly associated with cancer of the oral cavity, oropharynx and hypopharynx.

A review on harmful effects of pan masala

Indian Journal of Cancer, 2015

Pan masala (PM) is a mixture of areca nut with slaked lime, catechu and other flavoring agents. I... more Pan masala (PM) is a mixture of areca nut with slaked lime, catechu and other flavoring agents. It is widely available and used by all the sections of the Indian society. It is genotoxic as it increases sister chromatin exchange and chromatin aberrations. Among humans, it is a leading cause of oral submucous fibrosis that often progresses to oral cancer. Among experimental animals, it leads to neoplastic lesions in lung, liver and stomach. It is hepatotoxic leading to increased level of enzymes, deranged carbohydrate and lipid metabolism. It is harmful to kidneys and testes leading to increased creatinine and sperm deformities respectively. PM is a very harmful substance affecting almost all organ systems, and there is immediate need for a national policy on complete ban on the production, storage, sale and marketing of PM.

Role of Robotics in Non-oropharyngeal Head and Neck Tumours

Indian Journal of Surgical Oncology, 2022

Transoral robotic surgery has been gaining widespread acceptance for the treatment of oropharynge... more Transoral robotic surgery has been gaining widespread acceptance for the treatment of oropharyngeal malignancies. It has shown tremendous growth in the field of non-oropharyngeal malignancies like thyroidectomy, neck dissection, and parapharyngeal tumours. Many studies have aimed at studying the safety and efficacy of the technique. The literature is abundant for procedures and treatment protocols for oropharyngeal malignancy; however, there is paucity on its usability in non-oropharyngeal malignancy. We aim to review the literature to analyse the usability of robotics in non-oropharyngeal tumours and study the evolution and future applications of robotics in head and neck cancer. A thorough literature search using keywords “Transoral robotic surgery”, “TORS”, “ Robotics in Head and Neck”, “ Robot-assisted Neck Dissection”, “ Robotic Thyroidectomy”, “ Robotic Laryngectomy”, “ Robotics in salivary gland disease”, “ Parapharyngeal space”, “Systematic review”, and “Meta-analysis” was done. The articles were reviewed individually by each author for a dedicated sub-heading. A narrative review was formulated under the subheadings—thyroid surgery, salivary gland, neck dissection, parapharyngeal space, and laryngectomy. The role of robotics has expanded with the advances in technology. Non-oropharyngeal head and neck disease can be approached using robotics. Careful patient selection provides a significant advantage of function and cosmesis and helps in avoiding inadvertent complications. With our growing experience, we might see a surge in robot-assisted head and neck surgery.

Bilateral Tunnelized FAMM Islanded Flap for Reconstruction of Composite Defect of Tongue and Floor of Mouth: A Case Report

Journal of Maxillofacial and Oral Surgery, 2021

The work of Massarelli et al. is well known for popularizing t-FAMMIF, however to the best of our... more The work of Massarelli et al. is well known for popularizing t-FAMMIF, however to the best of our knowledge bilateral flap has never been harvested and inset together to reconstruct a composite defect. Larger unilateral flaps have been reported in literature but to harvest such a flap in patients of S.E Asian region would entail high propensity for trismus in the post op period as they have tendency for submucosal fibrosis owing to their guthka (chewing tobacco) chewing habits. Oral submucous fibrosis is contra-indication for this flap; however, some of our patients despite being chronic abusers of guthka do not have clinical presentation of OSMF and if the defect post ablation is appropriate are chosen to be candidates for reconstruction with the flap. In this select population harvesting larger flaps can potentially lead to trismus, a fact highlighted in the paper.

Optimum surgical margins in squamous cell carcinoma of the oral tongue: Is the current definition adequate?

Oral Oncology, 2020

OBJECTIVES To evaluate the impact of progressively increasing margin distances on locoregional re... more OBJECTIVES To evaluate the impact of progressively increasing margin distances on locoregional recurrence-free survival (LFRS) and determine an optimum margin distance for tongue cancers. METHODS We retrospectively reviewed the records of patients with squamous carcinoma of oral tongue, surgically treated between January 2012 and December 2013. The patients were divided based on ROC derived optimal distance and differences in LRFS per millimeter: margin distances with no significant difference in LRFS starting from 0 mm onwards (Group-I), from upper limit of Group-I to ROC cut-off (Group-II), and all values above it (Group-III). Group-II and III were matched for clinicopathologic factors and type of adjuvant therapy received. RESULTS 451 patients had a median LRFS of 29.4 months that included 32.1% of Stage I/II and 51.7% of Stage III/IV. Group-I consisted of 0--2.0 mm (2.0-2.1 mm (p-0.029)), Group-II form 2.1 to 7.5 (7.5-7.6 mm (p-0.042)) and Group-III were ≥ 7.6 mm. In the matched group, each millimeter increase in margin provided a 3.67 months survival advantage from 2.1 mm to 7.5 mm while a substantial advantage of 15 months was seen from 7.5 to 7.6 mm. No significant advantage was gained in LRFS when the margin was increased by a millimeter from the cut-off value (p-0.602). Among the patients that were not prescribed any adjuvant therapy, a significantly better LRFS was observed in Group III than Group II (HR-3.01, p-value = 0.002). CONCLUSION Based on these results, adequacy of surgical margins should be re-considered for oral tongue cancers.

Pedicled Latissimus Dorsi Myocutaneous Flap-an Effective Reconstructive Option for Extensive Buccal Cancer Resection in Resource Constrained and Salvage Settings

Indian Journal of Surgical Oncology, 2020

Free flaps are the gold standard for reconstruction of extensive buccal cancer resections. Howeve... more Free flaps are the gold standard for reconstruction of extensive buccal cancer resections. However, salvage surgeries in previously operated and radiated necks, cost, increased operating time, and patient co-morbidities limit their routine use in high volume and resource-constrained settings. Pectoralis major myocutaneous (PMMC) flap is the mainstay of reconstruction of large buccal defects. However, reconstruction becomes a challenge during salvage of recurrences where PMMC has been utilized in previous reconstruction and in female patients where PMMC harvest results in major donor site morbidity. A retrospective analysis of clinical data of 13 consecutive patients (eight male and five female) with through and through buccal cancer resection defects reconstructed using pedicled latissimus dorsi (LD) flap from July 2018 to September 2019 was performed. The indications of using an LD flap were salvage surgeries for recurrences where PMMC was used in earlier reconstruction, medical co-morbidities, vessel depleted necks, and financial constraints precluding use of free flaps. The mean follow-up period was 9.84 months. The mean operating time post-resection was 2 h and 26 min. The mean hospital stay was 12.61 days. All patients could be decannulated successfully (mean duration 9.69 days) and 12 could be weaned off feeding tube. None of the patients had any major flap related or donor site complications. Pedicled LD flap has a limited but an effective reconstructive role for extensive buccal cancer ablation as an alternative to free flaps and PMMC in salvage and resource-constrained situations.

Trends of Oral Cancer with Regard to Age, Gender, and Subsite Over 16 Years at a Tertiary Cancer Center in India

Indian Journal of Medical and Paediatric Oncology, 2018

Introduction: Oral cancers are among the most common cancers in the Indian subcontinent and tobac... more Introduction: Oral cancers are among the most common cancers in the Indian subcontinent and tobacco is the most common implicated etiologic agent for these cancers. Over last two decades, significant changes have occurred in the lifestyle of people in the subcontinent. Antitobacco legislations have made developed and awareness about the harmful effects of tobacco and related products have increased. We hypothesized that this would lead to change in tobacco use pattern and hence impact the trends of oral cancer in India. Methodology: We analyzed the hospital records of patients having buccal mucosa and tongue cancers at a tertiary care cancer center. We noted the trends of patients presenting with these cancers 4 yearly, over a period of 16 years and in this way tried to assess the impact of legislation and awareness activities upon cancer incidence and trends. Results:: This study has shown that the number of patients presenting with tongue and buccal mucosa cancers has not decrease...

Emergency department visits by head-and-neck cancer patients

Indian Journal of Palliative Care, 2019

Aim: This study was conducted to assess the disease status of head-and-neck cancer patients visit... more Aim: This study was conducted to assess the disease status of head-and-neck cancer patients visiting the emergency department (ED) and their reason for presentation. We wanted to analyze if these visits could be avoided by incorporating any changes in our clinical practice. Methods: This was a retrospective analysis of head-and-neck cancer patients attending the ED at a tertiary care cancer center in 2017. Clinical details were noted from the electronic medical records, and descriptive statistics was calculated. The analysis was performed using SPSS version 21 software. Results: Three hundred and thirty-nine head-and-neck cancer patients attended the ED. Of these, 80.2% were males and 48.1% of patients had oral cavity cancers. About 37.2% required palliative care treatment. Nearly, 47.2% of patients presented during their initial evaluation period. About 22.7% required hospital admission and only 14.7% required any sort of emergency intervention. Conclusion: Majority of visits to ED could have been avoided with better counseling of the patients and their attendants.

Frozen section is not cost beneficial for the assessment of margins in oral cancer

Indian Journal of Cancer, 2019

BACKGROUND Routine use of frozen section (FS) is a costly procedure and sparsely available in res... more BACKGROUND Routine use of frozen section (FS) is a costly procedure and sparsely available in resource poor countries. A proper cost benefit analysis may help to reduce its routine use and would empower surgeons to perform oral cancer surgeries without having FS facility. FS is performed to identify microscopic spread beyond gross disease that cannot be assessed clinically. OBJECTIVE Our primary aim was to determine the cost benefit analysis of FS in the assessment of margins in oral cavity squamous cell carcinoma (OSCC). MATERIALS AND METHODS Retrospective study of prospectively collected data of 1311 consecutive patients who were operated between January 2012 and October 2013. The gross and microscopic margin status of each patient was extracted from the patient's chart. The cost estimates were performed to calculate the financial burden of FS as well as expenses incurred on adjuvant treatment resulting from inadequate margins. RESULT Microscopic spread changed the gross margin status in 5.2% (65/1237) patients. Of this entire cohort of 1237 patients, FS helped 29 (2.3%) patients to achieve tumor free margin, and it changed the adjuvant treatment plan in 9 (0.7%) patients. The cost of FS for each patient was INR 11052. The cost-benefit ratio of FS was 12:1. Gross examination alone could have identified majority of the inadequate margins. CONCLUSION Frozen section for assessment of margin status bears poor cost-benefit ratio. Meticulous gross examination of the entire surgical specimen is sufficient to identify majority of inadequate margins.

Impact of age on elderly patients with oral cancer

European Archives of Oto-Rhino-Laryngology, 2018

Introduction In this study we have tried to analyze the impact of age on various clinico-patholog... more Introduction In this study we have tried to analyze the impact of age on various clinico-pathological parameters, treatment completion and subsequent survival in older patients. Materials and methods This is a retrospective analysis of 140 elderly (> 65 years) patients of oral cancer operated between January 2012 and December 2013. The patients were divided into two groups based upon their age that ≤ 70 years and > 70 years.Association of distribution of various clinico-pathological factors between different groups was assessed by using Chi-square test. Survival analysis was done using Kaplan Meir analysis. Univariate and multivariate analysis were performed. Results The two groups had similar distribution of various clinico-pathological factors. Disease free survival for the group ≤ 70 and > 70 years was 37.6 months and 36.4 months (p < 0.594). 13.5% and 7.8% patients > 70 years and ≤ 70 years were either advised or received sub-optimal adjuvant therapy (p < 0.002). Conclusion There is no difference distribution of various clinico-pathological factors and survival in patients of oral cancer ≤ 70 and > 70 years of age. Age did not affect survival. Majority of patients could complete the adjuvant therapy advised. Still, significantly more number of patients > 70 years could not receive/complete appropriate adjuvant therapy. Thus treatment needs to be tailored keeping in mind the individual's performance status and the co-morbidities.

Oral squamous cell carcinoma associated with oral submucous fibrosis have better oncologic outcome than those without

Oral surgery, oral medicine, oral pathology and oral radiology, Jan 4, 2017

Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with the use of are... more Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with the use of areca nut, and is mainly seen in the parts of Southeast Asia and the Indian subcontinent. We hypothesized that oral cancers occurring in presence of OSMF are clinicopathologically a distinct entity. We analyzed 289 treatment naïve patients of oral cancer. They were followed up for a median of 44 months. Association of presence of OSMF with other histopathological factors was done using the χ(2) test. Kaplan-Meier analysis was used for survival analysis. Oral squamous cell carcinoma along with OSMF was seen more often in younger patients (P < .001) and males (P < .007), and had a lower T-stage (P < .002) and N-stage (P < .000). These were thinner (P < .002), less infiltrative (P < .04) tumors and required adjuvant therapy less frequently (P < .017). The mean disease specific survival, overall for those with and without OSMF was 58.8 and 48.6 months (P < .002), and spe...

Intraoperative gross examination vs frozen section for achievement of adequate margin in oral cancer surgery

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2017

Introduction:Surgical margin status is one of the important prognostic factors in oral squamous c... more Introduction:Surgical margin status is one of the important prognostic factors in oral squamous cell carcinoma.The primary aim of the surgeon is to achieve a microscopically complete surgical resection during initial surgery.As there are no definite guidelines,few surgeons use Frozen section(FS) for margin assessment while others use Gross examination(GE). Materials and Methods:This is a retrospective analysis of prospectively collected data from Electronic Medical Records of 435 oral cavity cancer patients.As per the operating surgeon's preference, margin assessment was done using GE in 239(54.94%)specimens and FS was used in 196(45.05%) specimens.Surgery was the primary modality of treatment for all the patients followed by adjuvant therapy. Results:Incidence of close/positive margin was seen in 6.63% patients in FS group and in 6.69% patients in GE group(p-0.855).The sensitivity and specificity of frozen section were 45.45% and 98.8%, while for GE was 61.9% and 88.32% respectively.We found no survival benefit when FS was used for margin assessment(p-value-DFS:0.469,OS:0.325).Incidence of inadequate margins was similar in both the groups (p-0.608) even in patients with some form of previous treatment Conclusion:We propose the judicious use of frozen section rather than its routine use for margin assessment.The study proves that GE is an oncologic safe alternative to FS.

Perineural Invasion Independent Prognostic Factors in Patients with Gastric Cancer Undergoing Curative Resection

Asian Pacific Journal of Cancer Prevention, 2012

Objective: The prognostic significance of perineural invasion (PNI) in gastric cancer has been pr... more Objective: The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated but not clearly clarified. The objective of our study was to investigate the role of PNI as prognostic factor in patients undergoing curative surgical resection and without distant metastasis in comparison with other clinicopathological factors. Methods: Between 2001 and 2010, 287 cases of gastric adenocarcinoma underwent radical gastrectomy recorded in hospital based registries. PNI was assessed as positive when cancer cells were seen in the perinerium or neural fascicles intramurally. Categorical and continuous variables were summarized using descriptive statistics and compared using chi-square and Mann-Whitney U tests, respectively. Cancer related survival rates were estimated by the Kaplan-Meier method. Results: PNI was positive in 211 of 287 cancers (73%), with a positive relation to lymph node metastases and advanced stage (p=0.0001, p=0.0001, respectively), mural invasion, and lymphatic and blood vessel invasion (p=0.0001, p=0.0001, respectively). The median survival of the PNI positive patients was significantly shorter than that of their PNI negative counterparts (24.1 versus 38.2 months, p=0.008). In the multivariate analysis, we detected PNI was an independent prognostic factor (p=0.025, HR=1.21, 95% CL 1.08-2.3) along with classical clinicopathological variables such as lymph node involvement (p=0.001), pT stage (p=0.03), and LVI (p=0.017), but not age, gender, tumour localization, stage, histologic type, and surgery procedure. Conclusions: PNI positivity in gastric cancers was related mural invasion, lymph node involvement, advanced stage and lymphatic and venous blood vessels. The presence of PNI appeared as an independent prognostic factor on survival on multivariate analysis, not influenced by tumor stage, lymph node metastases and other classical factors.

Acute toxicities of adjuvant treatment in patients of oral squamous cell carcinoma with and without submucous fibrosis: A retrospective audit

Journal of Cancer Research and Therapeutics, 2016

To assess the severity of acute toxicities of postoperative adjuvant therapy on oral squamous cel... more To assess the severity of acute toxicities of postoperative adjuvant therapy on oral squamous cell carcinoma (OSCC) patients with and without submucous fibrosis (SMF). The study population comprised treatment naïve OSCC patients who underwent curative intent surgical resection from June 2010 to April 2011 followed by adjuvant treatment. Patients whose treatment details including toxicity profile were available were included in the study. One-hundred nine patients met the inclusion criteria of whom 36 had associated SMF and 73 no SMF. Overall, 35 patients received chemotherapy (CT) with radiotherapy (RT) and the rest only RT. Forty-two patients had centralized and 67 lateralized lesions. All patients with centralized lesions and 3 with lateralized lesion received radiation to bilateral face and neck. All others received ipsilateral radiation. The severity of mucositis, xerostomia, and skin toxicity (as per radiation therapy oncology group scale of acute toxicity) was compared between the SMF and non-SMF groups and patients with centralized and lateralized lesions. CT in addition to RT did not add significant to the assessed toxicities. Severe mucositis as well as treatment breaks were more in SMF group as compared to non-SMF group (P = 0.001 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 respectively). Severe mucositis and xerostomia were more in centralized than in lateralized lesions (P = 0.002 and 0.00 respectively). In subgroups of lateralized as well as centralized lesions, severe mucositis was more common in SMF patients than those without SMF (P = 0.01 and 0.02 respectively). OSCC patients with SMF have worse toxicity with adjuvant therapy and require good supportive care.

Prevalence of Functional Problems After Oral Cavity Malignancy Treatment at a Tertiary Center: Utilizing PSS HN (Performance Status Scale for Head and Neck) Scale

Journal of Maxillofacial and Oral Surgery, 2015

Background Oral cancer is the most common type of cancer occurring in India and it is equally imp... more Background Oral cancer is the most common type of cancer occurring in India and it is equally important to assess morbidities after treatment for optimal utilization of resources. Utilizing PSS HN we try to identify the patient population who are severely impaired and need aggressive rehabilitation. Method and Material The PSSHN questionnaire was administered by the treating physician to 100 consecutive oral cancer patients who completed their index treatment at least 6 months prior to accrual. Functional morbidities with score B50 were considered as significant. Results Prevalence of functional deficit of eating in public; deficit of understandability of speech and deficit of normalcy of diet were 28, 13 and 38 % respectively. Conclusion Type of resection either segmental mandibulectomy or major glossectomy, had most significant impact on concerned functional deficits and surgeries involving these defects should be carefully planned to involve free flap reconstruction and proper postoperative rehabilitation.

Palatal Cyst: An Unusual Case Report

International Journal of Otolaryngology and Head & Neck Surgery, 2013

Cyst is a fluid accumulated in a cavity lined by epithelium. Cyst over the hard palate is very in... more Cyst is a fluid accumulated in a cavity lined by epithelium. Cyst over the hard palate is very infrequent. Cyst is commonly seen along nasoalveolar duct or midline palatal cyst which are congenital. Only few cases of palatine cysts have been reported in literature. We present here a case of 21 years old male with a cystic lesion over the hard palate since 2 years.

Myoepithelioma of Tongue

International Journal of Otolaryngology and Head & Neck Surgery, 2013

Myoepithelioma is a rare neoplasm of the salivary glands, generally occurring in the parotid glan... more Myoepithelioma is a rare neoplasm of the salivary glands, generally occurring in the parotid gland and less often in the minor accessory salivary gland of the oral cavity. The histological appearance includes solid, myxoid and reticular growth patterns. Vimentin and S-100 protein are very sensitive but non-specific immunohistochemical markers of neoplastic myoepithelium. Conservative surgery is the treatment of choice. A case of myoepithelioma of the minor salivary gland of tongue is described, focusing on clinical behaviour, histopathological and immunohistochemical features.