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An increasing amount of literature highlights the existence of a small subset of T1\u2010T2N0 OTSCC, properly resected on a margin\u2010dependent basis, which conversely proved higher than expected rates of loco\u2010regional\/distant failure and disease\u2010specific mortality. These specific high\u2010risk tumors might not have a margin\u2010dependent disease and could possibly benefit from a more aggressive upfront loco\u2010regional treatment, especially addressing the so\u2010called T\u2010N tract. Widespread adoption of a histopathological risk model would allow early recognition of these high\u2010risk diseases and, consequently, intensification of the traditional treatment strategies in that specific niche. We reviewed the available knowledge trying to shed light on the potential determinants of the dismal prognosis of these high\u2010risk OTSCC, with special reference to the role of overlooked T\u2010N tract involvement and possible alternatives in terms of elective neck management and risk stratification.<\/jats:p>","DOI":"10.1002\/hed.26718","type":"journal-article","created":{"date-parts":[[2021,4,24]],"date-time":"2021-04-24T08:31:47Z","timestamp":1619253107000},"page":"2510-2522","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["High\u2010risk early\u2010stage oral tongue squamous cell carcinoma, when free margins are not enough: Critical review"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2677-8091","authenticated-orcid":false,"given":"Andrea","family":"Galli","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology San Raffaele Scientific Institute  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