Oral cancer Principles of Surgical Management

1. Dr Ashraf Abu Karaky The University of Jordan Oral cancer Principles of Surgical Management

2. Investigations • Surgical biopsy L A or G A Incisional or Excisional Referral before of after biopsy Site and principles of biopsy

3. Investigations • FNAB • Radiography • CT • Radionuclide studies • Ultrasound

4. Management of primary tumour • Choice of treatment Surgery Radiotherapy Chemotherapy

5. Choice of treatment • Site of origin Surgery is preferred for tumours arising on or involving alveolar processes For other sites surgery and radiotherapy are alternatives

6. Choice of treatment • Stage of disease Surgery is preferred in very smell lesions and very large lesions if operable! Bone involvement Radiotherapy; not operable tumours patient medical conditions Moderate sized tumours are contraversial

7. Choice of treatment • Previous irradiation

8. Choice of treatment • Histology Malignant melanoma and adenocarcinoma are relatively radioresistance Verrucous carcinoma is better treated surgically as radiotherapy induces anaplastic transformation Level of deferentiation of scc has no influence on its management

9. Choice of treatment • Age

10. Management according to site • Lip Tumours tend to spread laterally rather than infiltrating deeply If untreated spread to anterior triangle and invade the mandible L N metastasis occurs late

11. Reconstruction of the Upper Lip For defects that cover up to 50% of the upper lip, primary closure as described for the lower lip is performed. For defects that involve between one third and two thirds of the upper lip, the Abbe and Estlander flaps are preferred. For defects that involve at least two thirds of the upper lip, use a modified Burow technique, which uses perialar crescentic excisions and laterally based advancement flaps. Reverse Karapandzic flap can be performed

12. Reconstruction of the Lower Lip Lower lip reconstruction depends on the defect size. Defects smaller than one third of the lip can be repaired with a V or W resection, followed by primary 3-layer closure. V resection for smaller defects and W for larger defects. Defects between one third and two thirds of the lip can be repaired with the staircase technique, which entails progressive horizontal distances that involve half of the defect width. Defects that cover more than 60% of the lip usually require rotational flaps to be closed (eg, Abbe, Estlander, Bernard, Gillies, McHugh, Karapandzic).

13. Abbe Flap

15. V + Staircase Techniques

16. Carcinoma of the tongue • If less than one third of the tongue is excised no need for reconstruction • Hemiglossectomy; split thickness graft, radial fore arm flap • Total glossectomy; preserve one hypoglossal nerve, pectoralis major muscle flap • Need for Mandible resection

24. Floor of the mouth • Early spread to alveolas and lymph nodes • Access • Recostruction with local or regional or free flaps

26. BUCCAL MUCOSA • Lesions strictly confined to the buccal mucosa should be excised widely including buccinator muscle

27. Management of the neck • Neck dissection • Radiotherapy

28. Neck dissection • Supra-omohyoid neck dissection; N0 • Elective Neck Dissection; N0 Accessory nerve, SCM muscle, IJ Vein • Radical Neck Disscetion; N1, N2a,N2b

29. Radiotherapy in neck managenent • N2c, N3 • Extra-capsular spread

30. Thank you