- Email: [email protected]
Significance of mild and moderate margin dysplasia in disease free survival of oral cancer patients
Oral Presentation Table 2b Graph comparing mean scores on postoperative satisfaction questionnaire for patients who screened positive vs. negative for OCD (**p < 0.01).
e69
for newer diagnostic methods such as optical assessment in oral tongue cancers.
Reference Thursfield, V., Giles, G., & Farrugia, H. (2014). Cancer in Victoria: statistics & trends 2013. Melbourne: Cancer Council Victoria.
http://dx.doi.org/10.1016/j.ijom.2015.08.567 Significance of mild and moderate margin dysplasia in disease free survival of oral cancer patients S. Gokavarapu Basavatarakam Indo American Cancer Hospital and Research Centre, Hyderabad, India
Findings: Following OS, there was a significant reduction in the prevalence of BDD and OCD among the patients, and a significant time-dependent decrease of anxiety over the postoperative period; depression symptoms were unchanged (Table 1). Patients with more severe facial deformities prior to surgery showed significantly greater postoperative improvement in BDD symptomatology. Finally, pre- and postoperative BDD and postoperative OCD were significantly correlated with outcome dissatisfaction (Tables 2a and 2b). Conclusion: The effects of pre-existing BDD should be considered by oral and maxillofacial surgeons in recommending OS to patients with these conditions. http://dx.doi.org/10.1016/j.ijom.2015.08.566 Are incisional tongue biopsies for squamous cell carcinoma representative? T. Gnanasekaran ∗ , S. Latis, T. Iseli, D. Wiesenfeld The Royal Melbourne Hospital, Melbourne, Australia Background: Head and neck cancer is a significant health burden in Victoria with 786 new head and neck cancer cases, including 327 oral cancer cases in 2013.1 Accuracy of diagnosis and prompt management is vital given that the oral cavity cancer 5 year survival is 62% in males and 65% in females.1 Objectives: This paper will analyse how accurate incisional tongue biopsies were in predicting Squamous Cell Carcinoma in a tertiary institution within Victoria over a 10 year period (2005–2014). Methods: The data was collected from the hospital’s ACCORD Head & Neck database, with subsequent medical record review. Findings: There were 153 cases of incisional biopsies of the tongue that had subsequent wide local excisions. Of the cases examined, 12 cases were non-SCC and 8 of these cases were upgraded to SCC on the basis of the wide local excision (66.6%). Of the patients initially diagnosed with SCC, 19 had inconsistent pathology on wide local excision including no residual tumour identified 12, and varying degrees of dysplasia 5 (13.5%). Conclusions: This study highlights the need to further investigate factors that may lead to an incorrect diagnosis being made on biopsy, such as sampling errors. Consideration should be given to excisional biopsies of suspicious lesions <1 cm and multiple biopsies of large superficial lesions. There may be opportunity
Background: Margin status in oral cancer had been controversial, positive margins are associated with decreased disease free survival (DFS), however; the criteria for margin positivity had been variable among various authors with some of them considering dysplasia at the margin as positive and others not considering the same. Objective: To investigate the impact of margin dysplasia as an independent prognostic factor in the prognosis of primary squamous cell carcinoma of oral cavity. Methods & findings: Authors investigated DFS in primary oral cancer patients treated at a tertiary cancer centre between Jan 2010 to Dec 2011 retrospectively in a multivariate cox regression model. The mean age of the patients studied was 49.8 ± 12.9 years. 65.7% (n = 203) of the patients studied were males Table 1. Median period of follow up was 37 months, 71(29.5%) patients died. Patients with mild and moderate dysplasia showed lower DFS when compared to patients without dysplasia, however; it was not significant. There was no significant association between mild and moderate dysplasia and second primary development (p = 0.758) Table 2 or locoregional recurrence (p = 0.885) Table 3. In the multivariable Cox-regression model, increased dysplasia from mild to moderate had decreased DFS; HR: 1.47 (95% CI: 0.72, 3.01), however, it was not significant (p = 0.293) Table 4 (Fig. 1).
Fig. 1. Illustrates Kaplan–Meier survival curve for DFS in patients without margin dysplasia and with mild and moderate margin dysplasia.
e70
Oral Presentation
Table 1 Association of various prognostic factors with DFS. Parameters
N
Age <50 years ≥50 years Gender Male Female Site Tongue Buccal mucosa Gingiva Tobacco use Yes No Grade MDSCC WDSCC PDSCC Lymphovascular spread Absent Present Perineural Invasion Absent Present Stage I II III IVA T-stage T1 T2 T3 T4 Neck status N0 N1 N2 Dysplasia No Mild Moderate
Table 3 Association of locoregional recurrence to margin dysplasia (P = 0.885).
Disease free survival/death n (%)
P value
135 105
50 (37.0) 27 (25.7)
0.071
161 79
54 (33.5) 23 (29.1)
0.557
125 101 14
31 (24.8) 41 (40.6) 5 (35.7)
0.039
151 89
49 (32.5) 28 (31.5)
0.887
69 168 3
35 (50.7) 41 (24.4) 1 (33.3)
<0.0001
229 11
72 (31.4) 5 (45.5)
0.337
223 17
66 (29.6) 11 (64.7)
0.005
59 67 30 84
4 (6.8) 12 (17.9) 14 (46.7) 47 (56.0)
<0.0001
73 104 13 50
10 (13.7) 31 (29.8) 7 (53.8) 29 (58.0)
<0.0001
155 34 51
30 (19.4) 17 (50.0) 30 (58.8)
<0.0001
196 15 29
62 (31.6) 5 (33.3) 10 (34.5)
0.949
Absent
Not developed
Mild Moderate Total
No
Moderate Total
Total
Developed
189 96.4% 15 100.0% 28 96.6%
7 3.6% 0 0% 1 3.4%
196 100.0% 15 100.0% 29 100.0%
232 96.7%
8 3.3%
240 100.0%
Total
Recurred
154 78.6% 11 73.3% 23 79.3%
42 21.4% 4 26.7% 6 20.7%
196 100.0% 15 100.0% 29 100.0%
188 78.3%
52 21.7%
240 100.0%
Table 4 Multivariate Cox-regression model to assess the association of DFS to various factors prognostic factors. Parameters
Second primary oral cancer
No
Margin dysplasia
Mild
Table 2 Association of second primary oral cancer to margin dysplasia (P = 0.758).
Margin dysplasia
Locoregional recurrence
Age <50 years ≥50 years Gender Male Female Tobacco use Yes No Site Tongue Buccal mucosa Gingiva Dysplasia No Mild Moderate HPE diagnosis MDSCC WDSCC PDSCC Perineural invasion Absent Present Lymphovascular spread Absent Present T stage T1 T2 T3 T4 Neck status N0 N1 N2 Margin status Depth of invasion
N
Adjusted hazard ratio (95% confidence intervals)
P value
135 105
1.37 (0.82, 2.27) 1.00
0.226
161 79
1.48 (0.83, 2.64) 1.00
0.187
151 89
1.47 (0.82, 2.63) 1.00
0.186
125 101 14
0.66 (0.21, 2.07) 0.91 (0.30, 2.73) 1.00
0.478 0.868
196 15 29
1.00 1.92 (0.72, 5.11) 1.47 (0.72, 3.01)
69 168 3
1.38 (0.17, 11.20) 0.54 (0.07, 4.23) 1.00
223 17
1.00 1.55 (0.71, 3.41)
0.273
229 11
1.00 0.43 (0.14, 1.31)
0.137
73 104 13 50
1.00 2.31 (1.06, 5.04) 6.48 (2.11, 19.86) 3.80 (1.52, 9.52)
0.035 0.001 0.004
155 34 51 240 240
1.00 3.01 (1.54, 5.87) 2.98 (1.67, 5.32) 1.04 (0.95, 1.13) 1.03 (0.99, 1.07)
0.001 <0.0001 0.392 0.191
0.193 0.293 0.762 0.556
Oral Presentation Conclusion: Dysplasia at the margin may not be a significant independent prognostic factor; specifically mild and moderate dysplasia. http://dx.doi.org/10.1016/j.ijom.2015.08.568 Role of computer-assisted navigation in reconstruction of unilateral delayed zygomatic complex fracture: a randomized controlled trial X. Gong ∗ , Y. Zhang, Y. He, J.G. An, Y. Yang, Y. Zhao Peking University School and Hospital of Stomatology, Beijing, PR China Background: In surgical reconstruction of the delayed zygomatic complex fractures, the loss of normal anatomic landmarks owing to the malunion of the fracture ends makes it difficult to determine the correct positions of displaced fragments and original zygoma contour. Development of CAD/CAM and following appeared 3-D model surgery and application of the individual designed guiding template greatly relieved surgeons of bewilderment in operating. However, precise deliver of surgical simulation plans is still not realized through the fabricated template. Intraoperative navigation has brought an effective solution to this problem. Objectives: In order to validate the role of navigation technique in improving treatment results, a randomized controlled trial was conducted. Methods: Sixty-two patients with unilateral delayed ZMC fracture were included in this study. Group A (n = 31, using navigation guiding repositioning) and group B (n = 31, using template guiding repositioning). The zygomatic projection and width between bilateral zygomatic arches were measured on CT of 3 month postoperatively. Findings: The postoperative 3-D CT measurement showed that the difference of zygomatic projection on both sides was 1.21 (0.60–2.05) mm in group A, and 2.11 (1.39–2.64) mm in group B, with significant differences between two groups. The difference of zygomatic width on both sides was 1.12 (0.76–1.87) mm in group A, and 1.40 (0.85–2.55) mm in group B, without significant differences between two groups. Follow-up data were obtained for 48 participants. The VAS scores showed significant difference in the two groups (P < 0.01). Conclusions: Navigation guiding surgery can improve the outcome of the unilateral delayed ZMC fracture. http://dx.doi.org/10.1016/j.ijom.2015.08.569 Head and neck skin cancer – a protocol for efficient management D. Goodisson Hawkes Bay Regional Hospital, Hastings, New Zealand Background: The incidence of melanoma (MSC) and nonmelanoma skin cancer (NMSC) is increasing in Australia, New Zealand, United Kingdom and United States of America. By the age of 70, two out of three Australians will have had a skin cancer removed. In Australia and New Zealand, skin cancers consume more health care dollars than any other cancer type. Poorly managed skin cancers may carry significant morbidity and mortality. Accurate diagnosis, treatment and cosmetic and functional reconstruction are the three pillars of management of head and neck
e71
skin cancer management. With increasing pressures on health care budgets, this should be as cost effective as possible. Objectives: Propose a protocol for the efficient management of NMSC. Methods: 500 skin cancer cases, managed per protocol, were reviewed. Incomplete excision and five year recurrence rates were reported Findings: At 1% 5 year recurrence for primary tumours and 5% recurrence for recurrent tumours, the effectiveness of this technique is similar to Mohs surgery. There were no inappropriate resections Conclusions: Our protocol for management of NMSC is simple and appears to offer efficient tumour clearance. It has 4 intervention points; 1. Dermatocopy allows accurate prediction of significant skin lesions. 2. Incision biopsy on suspicious lesions avoids inappropriate resections. 3. Dermatoscopic assistance at the time of surgery helps with accurate resection margins 4. The staged approach to resection with delayed reconstruction ensures clearance prior to reconstruction http://dx.doi.org/10.1016/j.ijom.2015.08.570 Single institution experience with sentinel lymph node biopsy for early stage oral SCC A. Greenstein 1,∗ , J. McMahon 1 , C. MacIver 1 , C. Wales 1 , D. McLellan 1 , I. Mclaughlin 1 , S. Hislop 2 1 2
Southern General Hospital, Glasgow, Scotland, UK Crosshouse Hospital, Kilmarnock, Scotland, UK
Background: Sentinel lymph node biopsy (SNLBx) for head and neck oncology, such as melanomas, have been utilised for a number of years. However, their application for oral SCC has become more widespread. This study will show that introducing SLNBx into contemporary head and neck practice will significantly reduce neck dissection related morbidity. Aim: To describe the introduction of SNLBx for oral SCC into contemporary head and neck practice and examine patterns of lymph node metastasis encountered and preliminary outcomes. Methods: We will examine a consecutive series of patients undergoing SNLBx for oral cavity primaries between September 2010 to February 2015. The first ten patients also underwent simultaneous selective neck dissections (validation phase). Technical, pathological and clinical aspects will be described. Results: Of a total of 48 patients recruited onto the study it was found that 16 were found to be pN+ on SNLBx. The primary subsites for resection of oral SCC were oral tongue, soft palate, and mandibular alveolus. The median number of SLNBx recovered was 2 with a range from 1 to 6. Levels I to IV were seen on SNLBx. Conclusions: SNLBx is a straightforward procedure to introduce into the practice of an experience head and neck team and has the potential to significantly reduce neck dissection related morbidity as well as identify a subset of patients with early stage disease who could benefit from advent treatment. http://dx.doi.org/10.1016/j.ijom.2015.08.571
e69
for newer diagnostic methods such as optical assessment in oral tongue cancers.
Reference Thursfield, V., Giles, G., & Farrugia, H. (2014). Cancer in Victoria: statistics & trends 2013. Melbourne: Cancer Council Victoria.
http://dx.doi.org/10.1016/j.ijom.2015.08.567 Significance of mild and moderate margin dysplasia in disease free survival of oral cancer patients S. Gokavarapu Basavatarakam Indo American Cancer Hospital and Research Centre, Hyderabad, India
Findings: Following OS, there was a significant reduction in the prevalence of BDD and OCD among the patients, and a significant time-dependent decrease of anxiety over the postoperative period; depression symptoms were unchanged (Table 1). Patients with more severe facial deformities prior to surgery showed significantly greater postoperative improvement in BDD symptomatology. Finally, pre- and postoperative BDD and postoperative OCD were significantly correlated with outcome dissatisfaction (Tables 2a and 2b). Conclusion: The effects of pre-existing BDD should be considered by oral and maxillofacial surgeons in recommending OS to patients with these conditions. http://dx.doi.org/10.1016/j.ijom.2015.08.566 Are incisional tongue biopsies for squamous cell carcinoma representative? T. Gnanasekaran ∗ , S. Latis, T. Iseli, D. Wiesenfeld The Royal Melbourne Hospital, Melbourne, Australia Background: Head and neck cancer is a significant health burden in Victoria with 786 new head and neck cancer cases, including 327 oral cancer cases in 2013.1 Accuracy of diagnosis and prompt management is vital given that the oral cavity cancer 5 year survival is 62% in males and 65% in females.1 Objectives: This paper will analyse how accurate incisional tongue biopsies were in predicting Squamous Cell Carcinoma in a tertiary institution within Victoria over a 10 year period (2005–2014). Methods: The data was collected from the hospital’s ACCORD Head & Neck database, with subsequent medical record review. Findings: There were 153 cases of incisional biopsies of the tongue that had subsequent wide local excisions. Of the cases examined, 12 cases were non-SCC and 8 of these cases were upgraded to SCC on the basis of the wide local excision (66.6%). Of the patients initially diagnosed with SCC, 19 had inconsistent pathology on wide local excision including no residual tumour identified 12, and varying degrees of dysplasia 5 (13.5%). Conclusions: This study highlights the need to further investigate factors that may lead to an incorrect diagnosis being made on biopsy, such as sampling errors. Consideration should be given to excisional biopsies of suspicious lesions <1 cm and multiple biopsies of large superficial lesions. There may be opportunity
Background: Margin status in oral cancer had been controversial, positive margins are associated with decreased disease free survival (DFS), however; the criteria for margin positivity had been variable among various authors with some of them considering dysplasia at the margin as positive and others not considering the same. Objective: To investigate the impact of margin dysplasia as an independent prognostic factor in the prognosis of primary squamous cell carcinoma of oral cavity. Methods & findings: Authors investigated DFS in primary oral cancer patients treated at a tertiary cancer centre between Jan 2010 to Dec 2011 retrospectively in a multivariate cox regression model. The mean age of the patients studied was 49.8 ± 12.9 years. 65.7% (n = 203) of the patients studied were males Table 1. Median period of follow up was 37 months, 71(29.5%) patients died. Patients with mild and moderate dysplasia showed lower DFS when compared to patients without dysplasia, however; it was not significant. There was no significant association between mild and moderate dysplasia and second primary development (p = 0.758) Table 2 or locoregional recurrence (p = 0.885) Table 3. In the multivariable Cox-regression model, increased dysplasia from mild to moderate had decreased DFS; HR: 1.47 (95% CI: 0.72, 3.01), however, it was not significant (p = 0.293) Table 4 (Fig. 1).
Fig. 1. Illustrates Kaplan–Meier survival curve for DFS in patients without margin dysplasia and with mild and moderate margin dysplasia.
e70
Oral Presentation
Table 1 Association of various prognostic factors with DFS. Parameters
N
Age <50 years ≥50 years Gender Male Female Site Tongue Buccal mucosa Gingiva Tobacco use Yes No Grade MDSCC WDSCC PDSCC Lymphovascular spread Absent Present Perineural Invasion Absent Present Stage I II III IVA T-stage T1 T2 T3 T4 Neck status N0 N1 N2 Dysplasia No Mild Moderate
Table 3 Association of locoregional recurrence to margin dysplasia (P = 0.885).
Disease free survival/death n (%)
P value
135 105
50 (37.0) 27 (25.7)
0.071
161 79
54 (33.5) 23 (29.1)
0.557
125 101 14
31 (24.8) 41 (40.6) 5 (35.7)
0.039
151 89
49 (32.5) 28 (31.5)
0.887
69 168 3
35 (50.7) 41 (24.4) 1 (33.3)
<0.0001
229 11
72 (31.4) 5 (45.5)
0.337
223 17
66 (29.6) 11 (64.7)
0.005
59 67 30 84
4 (6.8) 12 (17.9) 14 (46.7) 47 (56.0)
<0.0001
73 104 13 50
10 (13.7) 31 (29.8) 7 (53.8) 29 (58.0)
<0.0001
155 34 51
30 (19.4) 17 (50.0) 30 (58.8)
<0.0001
196 15 29
62 (31.6) 5 (33.3) 10 (34.5)
0.949
Absent
Not developed
Mild Moderate Total
No
Moderate Total
Total
Developed
189 96.4% 15 100.0% 28 96.6%
7 3.6% 0 0% 1 3.4%
196 100.0% 15 100.0% 29 100.0%
232 96.7%
8 3.3%
240 100.0%
Total
Recurred
154 78.6% 11 73.3% 23 79.3%
42 21.4% 4 26.7% 6 20.7%
196 100.0% 15 100.0% 29 100.0%
188 78.3%
52 21.7%
240 100.0%
Table 4 Multivariate Cox-regression model to assess the association of DFS to various factors prognostic factors. Parameters
Second primary oral cancer
No
Margin dysplasia
Mild
Table 2 Association of second primary oral cancer to margin dysplasia (P = 0.758).
Margin dysplasia
Locoregional recurrence
Age <50 years ≥50 years Gender Male Female Tobacco use Yes No Site Tongue Buccal mucosa Gingiva Dysplasia No Mild Moderate HPE diagnosis MDSCC WDSCC PDSCC Perineural invasion Absent Present Lymphovascular spread Absent Present T stage T1 T2 T3 T4 Neck status N0 N1 N2 Margin status Depth of invasion
N
Adjusted hazard ratio (95% confidence intervals)
P value
135 105
1.37 (0.82, 2.27) 1.00
0.226
161 79
1.48 (0.83, 2.64) 1.00
0.187
151 89
1.47 (0.82, 2.63) 1.00
0.186
125 101 14
0.66 (0.21, 2.07) 0.91 (0.30, 2.73) 1.00
0.478 0.868
196 15 29
1.00 1.92 (0.72, 5.11) 1.47 (0.72, 3.01)
69 168 3
1.38 (0.17, 11.20) 0.54 (0.07, 4.23) 1.00
223 17
1.00 1.55 (0.71, 3.41)
0.273
229 11
1.00 0.43 (0.14, 1.31)
0.137
73 104 13 50
1.00 2.31 (1.06, 5.04) 6.48 (2.11, 19.86) 3.80 (1.52, 9.52)
0.035 0.001 0.004
155 34 51 240 240
1.00 3.01 (1.54, 5.87) 2.98 (1.67, 5.32) 1.04 (0.95, 1.13) 1.03 (0.99, 1.07)
0.001 <0.0001 0.392 0.191
0.193 0.293 0.762 0.556
Oral Presentation Conclusion: Dysplasia at the margin may not be a significant independent prognostic factor; specifically mild and moderate dysplasia. http://dx.doi.org/10.1016/j.ijom.2015.08.568 Role of computer-assisted navigation in reconstruction of unilateral delayed zygomatic complex fracture: a randomized controlled trial X. Gong ∗ , Y. Zhang, Y. He, J.G. An, Y. Yang, Y. Zhao Peking University School and Hospital of Stomatology, Beijing, PR China Background: In surgical reconstruction of the delayed zygomatic complex fractures, the loss of normal anatomic landmarks owing to the malunion of the fracture ends makes it difficult to determine the correct positions of displaced fragments and original zygoma contour. Development of CAD/CAM and following appeared 3-D model surgery and application of the individual designed guiding template greatly relieved surgeons of bewilderment in operating. However, precise deliver of surgical simulation plans is still not realized through the fabricated template. Intraoperative navigation has brought an effective solution to this problem. Objectives: In order to validate the role of navigation technique in improving treatment results, a randomized controlled trial was conducted. Methods: Sixty-two patients with unilateral delayed ZMC fracture were included in this study. Group A (n = 31, using navigation guiding repositioning) and group B (n = 31, using template guiding repositioning). The zygomatic projection and width between bilateral zygomatic arches were measured on CT of 3 month postoperatively. Findings: The postoperative 3-D CT measurement showed that the difference of zygomatic projection on both sides was 1.21 (0.60–2.05) mm in group A, and 2.11 (1.39–2.64) mm in group B, with significant differences between two groups. The difference of zygomatic width on both sides was 1.12 (0.76–1.87) mm in group A, and 1.40 (0.85–2.55) mm in group B, without significant differences between two groups. Follow-up data were obtained for 48 participants. The VAS scores showed significant difference in the two groups (P < 0.01). Conclusions: Navigation guiding surgery can improve the outcome of the unilateral delayed ZMC fracture. http://dx.doi.org/10.1016/j.ijom.2015.08.569 Head and neck skin cancer – a protocol for efficient management D. Goodisson Hawkes Bay Regional Hospital, Hastings, New Zealand Background: The incidence of melanoma (MSC) and nonmelanoma skin cancer (NMSC) is increasing in Australia, New Zealand, United Kingdom and United States of America. By the age of 70, two out of three Australians will have had a skin cancer removed. In Australia and New Zealand, skin cancers consume more health care dollars than any other cancer type. Poorly managed skin cancers may carry significant morbidity and mortality. Accurate diagnosis, treatment and cosmetic and functional reconstruction are the three pillars of management of head and neck
e71
skin cancer management. With increasing pressures on health care budgets, this should be as cost effective as possible. Objectives: Propose a protocol for the efficient management of NMSC. Methods: 500 skin cancer cases, managed per protocol, were reviewed. Incomplete excision and five year recurrence rates were reported Findings: At 1% 5 year recurrence for primary tumours and 5% recurrence for recurrent tumours, the effectiveness of this technique is similar to Mohs surgery. There were no inappropriate resections Conclusions: Our protocol for management of NMSC is simple and appears to offer efficient tumour clearance. It has 4 intervention points; 1. Dermatocopy allows accurate prediction of significant skin lesions. 2. Incision biopsy on suspicious lesions avoids inappropriate resections. 3. Dermatoscopic assistance at the time of surgery helps with accurate resection margins 4. The staged approach to resection with delayed reconstruction ensures clearance prior to reconstruction http://dx.doi.org/10.1016/j.ijom.2015.08.570 Single institution experience with sentinel lymph node biopsy for early stage oral SCC A. Greenstein 1,∗ , J. McMahon 1 , C. MacIver 1 , C. Wales 1 , D. McLellan 1 , I. Mclaughlin 1 , S. Hislop 2 1 2
Southern General Hospital, Glasgow, Scotland, UK Crosshouse Hospital, Kilmarnock, Scotland, UK
Background: Sentinel lymph node biopsy (SNLBx) for head and neck oncology, such as melanomas, have been utilised for a number of years. However, their application for oral SCC has become more widespread. This study will show that introducing SLNBx into contemporary head and neck practice will significantly reduce neck dissection related morbidity. Aim: To describe the introduction of SNLBx for oral SCC into contemporary head and neck practice and examine patterns of lymph node metastasis encountered and preliminary outcomes. Methods: We will examine a consecutive series of patients undergoing SNLBx for oral cavity primaries between September 2010 to February 2015. The first ten patients also underwent simultaneous selective neck dissections (validation phase). Technical, pathological and clinical aspects will be described. Results: Of a total of 48 patients recruited onto the study it was found that 16 were found to be pN+ on SNLBx. The primary subsites for resection of oral SCC were oral tongue, soft palate, and mandibular alveolus. The median number of SLNBx recovered was 2 with a range from 1 to 6. Levels I to IV were seen on SNLBx. Conclusions: SNLBx is a straightforward procedure to introduce into the practice of an experience head and neck team and has the potential to significantly reduce neck dissection related morbidity as well as identify a subset of patients with early stage disease who could benefit from advent treatment. http://dx.doi.org/10.1016/j.ijom.2015.08.571