The reconstruction and rehabilitation of jaws following ablative surgery have been transformed in recent years by the development of computer-assisted surgery and virtual surgical planning. In this narrative literature review, we aim to discuss the current state-of-the-art jaw reconstruction, and to preview the potential future developments. The application of patient-specific implants and the “jaw-in-a-day technique” have made the fast restoration of jaws’ function and aesthetics possible. The improved efficiency of primary reconstructive surgery allows for the rehabilitation of neurosensory function following ablative surgery. Currently, a great deal of research has been conducted on augmented/mixed reality, artificial intelligence, virtual surgical planning for soft tissue reconstruction, and the rehabilitation of the stomatognathic system. This will lead to an even more exciting future for the functional reconstruction and rehabilitation of the jaw following ablative surgery.

Background: Guidelines recommended for resection of oral cancer define a free margin of ≥5 mm as clear and safe (R0). This statement was questioned recently based on the assumption that different surgical margins may hold different risk categories. The aim of this study was to investigate the impact of stratification of the surgical margins on the survival outcome of patients with oral cancer.Methods: In a cohort of 753 patients, the hazard ratio for local recurrence‐free survival (LRFS), overall survival (OS), and oral cancer‐specific survival (OCSS) were estimated for R0 resection, the close margin of 1–4 mm, involved resection borders but with free frozen sections. Competing risk factors were considered in the statistical regression model.Results: One hundred seventy‐three (23%) patients developed local recurrence and 316 (42%) died in the 5 follow‐up years. There was a gradual improvement in the LRFS, OCSS, OS with the increase of clear margin. OS showed a similar tendency.Conclusion: Not all patients with an R0cm status carry the same risk for impaired LRFS, OCSS, and OS. Their risk to develop recurrence is higher than those patients with R0 ≥5 mm but stratified risk management can be recommended according to the presented results.

Cisplatin is the standard for the chemoradiation of squamous cell carcinoma of the head and neck (HNSCC). Many patients cannot receive cisplatin due to impaired renal function. This study investigated carboplatin as an alternative option. In total, 131 patients assigned to two courses of cisplatin (20 mg/m²/d1-–5 or 25 mg/m²/d1–4) were matched to 45 patients not suitable for cisplatin and receiving carboplatin (AUC 1.0/d1–5 or AUC 1.5/d1–4). The endpoints included loco-regional control (LRC), metastases-free survival (MFS), overall survival (OS), toxicities, and the completion of chemotherapy. The patients in the carboplatin group were significantly older and had more G3 tumors. Otherwise, the baseline characteristics were balanced. The LRC rates at 2 and 3 years were 77% and 76% in the cisplatin group vs. 69% and 65% in the carboplatin group (p = 0.21). The MFS rates were 83% and 78% vs. 78% and 74% (p = 0.34) and the OS rates 83% and 79% vs. 83% and 75% (p = 0.64), respectively. The outcomes were not significantly different in the subgroups receiving definitive or adjuvant chemoradiation. No significant differences were found regarding toxicities. Non-significantly more patients in the carboplatin group completed their chemotherapy (78% vs. 66%, p = 0.15). Carboplatin was associated with similar outcomes and toxicities as cisplatin, although these patients had worse renal function, more aggressive tumors, and were older. Given the limitations of this study, carboplatin appears an option for patients not suitable for cisplatin.

The epithelial-mesenchymal transition (EMT) is a biological mechanism in multiple pathophysiological diseases. Related alterations in cadherin expression play a crucial role in carcinogenesis, progression, angiogenesis, and immune response. EMT cells exhibit a transition from an epithelial to a mesenchymal phenotype (cadherin-switch). This process is characterized by the de novo development of N-cadherin (N-CAD), which replaces E-cadherin (E-CAD) and signifies an increased migratory capacity and malignant transformation. The cadherin switch is a hallmark of EMT and has been studied in various cancer entities. We predicted that the cadherin switch in the primary and recurrent oral squamous cell carcinoma (re-OSCC) tissues is an inherent characteristic of the tumor, affects the biologic behavior, and further reflects the post-recurrence survival outcome of these patients. Survival outcome was analyzed by calculating the post-recurrence survival of the high-risk group and correlating the standardized h-score-based IHC expression of both cadherin types with the clinical follow-up. 94 patients with re-OSCC were observed within the cohort. Tissue samples from both primary and recurring tumors were collected. There was a significant association between loss of E-CAD expression and both oral cancer-specific and overall survival, (HR=2.72, CI:1.50-4.95, p=0.001) and (HR=3.84, CI:1.93-7.63, p=0.001), respectively, for expression loss higher than 60%. There was no statistically significant correlation between N-CAD de novo expression and Overall, oral cancer-specific and disease-free post-recurrence survival. The current study clearly shows that cadherin-switch, identified as E-CAD loss and N-CAD de novo expression in the invasion front of a re-OSCC, appears to be an inherent histological hallmark that does not change from primary manifestation to recurrence within the same tumor, regardless of the form of adjuvant therapy used for the primary tumor. The loss of E-CAD expression in re-OSCC is an independent risk factor for poor survival, and may be used to stratify therapy and de/escalate the multimodal treatment.

Background/Objectives: Perineural (PnI), lymphatic (LI), and vascular invasion (VI) in tumor specimens are supposed to worsen the clinical course of oral squamous cell carcinoma (OSCC) and negatively influence survival outcomes. Despite this, these histologic features have not been implemented in the international staging recommendation for OSCC and their prognostic role remains questionable due to inconsistent findings in the related literature. Methods: To investigate the impact of PnI, LI, and VI on oral cancer-specific (OCSS), recurrence-free (RFS), and overall survival (OS), we hypothesized that these histologic features are independent risk factors for poor survival and therefore considered within a prospectively maintained single-center cohort of patients with OSCC. LI and VI were assessed together and reported as lymphovascular invasion (LVI). Results: This study included 439 patients with primary OSCC. Sixty-nine Patients (21.9%) had at least one of the two risk factors. Within the 5-year follow-up period, 61 of these patients (64%) died, and 30 patients (31%) developed locoregional recurrences. Both perineural and lymphovascular invasion were strongly correlated with the presence of lymph node metastasis. PnI and LVI were investigated separately using an adjusted Cox’s proportional hazards regression model. In addition to higher tumor size and the presence of nodal disease (higher stage) the presence of LVI was associated with poor OS, OCSS, and RFS on multivariate analysis, while PnI was associated with reduced OS. In stage III/IV postoperative radiotherapy improved survival in patients with PnI but not with LVI. Conclusions: We conclude that the evidence of LVI in tumor specimens should be considered a high-risk factor when planning adjuvant treatment and monitoring patients with OSCC.