SURGICAL APPROACHES FOR ORAL CAVITY CANCERS

  • A variety of surgical approaches:
    • Are available for resection of primary tumors of the oral cavity
  • The choice of a particular approach will depend on factors such as:
    • The size and site (anterior versus posterior) of the primary tumor
    • As well as its depth of invasion
    • Proximity to the mandible or maxilla
  • Factors such as dentition, size of the oral aperture, trismus, and the size and mobility of the tongue:
    • Also influence selection of the surgical approach
  • The various surgical approaches such as:
    • Peroral, mandibulotomy, lower cheek flap approach, visor flap approach, and upper cheek flap approach are shown in Figure
  • The transoral approach has wider applications with technologic advances using:
    • Lasers (transoral laser microsurgery [TLM]) and robotics (transoral robotic surgery [TORS])
Various surgical approaches. A, Peroral. B, Mandibulotomy.
C, Lower cheek flap. D, Visor flap. E, Upper cheek flap.
  • When the peroral approach does not offer adequate exposure:
    • The visor flap or cheek flap approaches (upper or lower) become necessary
  • The visor flap approach:
    • Provides sufficient exposure for anteriorly located lesions:
      • But is not satisfactory for tumors located in the posterior oral cavity
    • The benefit of this approach is that it avoids a lower lip–splitting incision:
      • But produces permanent numbness of the chin:
        • Because the mental nerves need to be transected for adequate mobilization of the flap
      • It also may cause sagging of the lower lip and drooling:
        • Because of a loss of support and sensation:
          • Thus its utility is limited
  • The lower cheek flap approach:
    • Requires a midline lip–splitting incision that is continued laterally into the neck for exposure and neck dissection:
      • This approach provides excellent exposure for nearly all tumors of the oral cavity:
        • Except those of the upper gum and hard palate
  • Mandible resection (marginal or segmental) and reconstruction:
    • Require the lower cheek flap approach in most instances
  • The lower cheek flap approach:
    • Is required for marginal or segmental mandibulectomy of tumors adjacent to the body of the mandible
  • The upper cheek flap approach (the Weber-Ferguson incision and its modifications):
    • Is required for resection of larger tumors of the hard palate and upper alveolus:
      • Particularly if they are posteriorly located
  • Access to larger tumors of the tongue, particularly those closer to the base of the tongue where the mandible is not involved:
    • Requires wider exposure for resection:
      • A mandibulotomy or mandibular osteotomy is an excellent mandible sparing surgical approach designed to gain access to the oral cavity or oropharynx for resection of primary tumors otherwise not accessible through the open mouth or by the lower cheek flap approach (Figure)
A mandibulotomy is an excellent mandible-sparing surgical
approach to gain access to bulky tumors of the oral cavity or
oropharynx.

#Arrangoiz #CancerSurgeon #SurgicalOncologist #HeadandNeckSurgeon #MountSinaiMedicalCenter #MSMC #HeadandNeckCancer #OralCavityCancer #SCC @SquamousCellCarcinoma #Miami #Mexico

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