Squamous cell carcinoma (SCC) of the tongue is a common cancer across the globe. These cancers have a high predilection for nodal metastasis and a high incidence of occult metastasis. The management of clinically negative neck nodes (N0) remains controversial. We have undertaken a prospective study to evaluate the rate of occult nodal metastasis, the characteristic of metastasis, and assess the usefulness of tumor depth as a predictor of metastasis and as a guide to treat the neck. Prospective study between January 2000 to December 2005. Patients with SCC of the anterior 2/3rd of tongue with N0 neck were included. Wide excision of the primary and subsequent modified radical neck dissection (in patients with tumor depth>4 mm) was performed. Postoperative radiotherapy was given in patients with lymph node metastasis. Patients who had no node metastasis (p N -ve) were observed. The total number of eligible patients was 180. Occult lymph node metastasis (p N +ve) was seen in 122 (62.2%) patients (p<0.001), multiple levels of node involvement in 79 (70.5%) patients and extracapsular spread (ECS) in 38 (33.6%) patients. Patients in the p N +ve group who were disease free was 63.1% as compared to 68.2% in the p N -ve group (p=0.36). Recurrence was seen in 28 (36.8%) patients of p N +ve group and 14 (31.8%) patients of p N -ve group. Early cancer of tongue with tumor depth >4 mm was associated with predominantly high grade tumors, high incidence of occult nodal metastasis, multiple levels of nodal involvement and ECS. The disease free status of patients with occult metastasis who were treated was similar to that of patients with no nodal metastasis. Elective neck dissection appears essential for early oral tongue cancer with tumor depth >4 mm as there is no investigational modality which can reliably identify patients without occult metastasis.

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<p class="abstract"><strong>Background:</strong> The nasolabial flap is a simple, yet efficient method of soft tissue reconstruction with a very reliable blood supply which can be used to reconstruct soft tissue defects of various parts of the oral cavity. Aim of the study was to study the effectiveness of the inferiorly based nasolabial flaps for reconstruction in early oral cancer patients.</p><p class="abstract"><strong>Methods:</strong> 28 patients with T1 or T2 malignant lesions of the oral cavity were studied retrospectively who underwent reconstructions using the inferiorly based nasolabial flap. Flap viability, wound problems, infections, function, scar and recurrence were noted post-operatively for all the patients included in the study. All patients were followed up for a minimum of 6 months after the surgery.  </p><p class="abstract"><strong>Results:</strong> The nasolabial flap was used to reconstruct defects of buccal mucosa, oral commissure, lower lip, lateral border of the tongue, hard palate and the floor of the mouth. The flap was viable in all patients with no recurrences. Cosmetic and functional outcomes were good. However few patients developed minor complications like post-operative trismus, severe wound contracture, ectropion and infection and wound dehiscence. Intra oral hair growth over the flap used were one of the main problems in the majority of male patients.</p><p><strong>Conclusions: </strong>If proper attention is given to flap designing, operative technique and post-operative management, the NLF is a viable and versatile option for reconstruction of small to intermediate defects of the oral cavity created post ablation of early tumors of the oral cavity.</p>

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