Blog

• The oral cavity represents the entrance to the upper aerodigestive tract:
  • Which begins at the lips and ends at the anterior surface of the faucial arch
  • It is lined by:
    • Squamous epithelium:
      • With interspersed minor salivary glands
• The oral cavity also contains the:
  • Dentoalveolar structures:
    • With the upper and lower dentition
• The oral cavity is continuously exposed to inhaled and ingested carcinogens:
  • Thus it is the most common site for the origin of malignant epithelial neoplasms in the head and neck region
  • Known carcinogens for oral cavity carcinoma include:
    • Those present in tobacco, alcohol, and betel nuts
    • The association of human papilloma virus with oral cancer:
      • Is not as well established as in oropharyngeal cancers
• Primary tumors of the oral cavity may arise from the:
  • Surface epithelium (most common)
  • Minor salivary glands
  • Submucosal soft tissues
  • Lesions of dentoalveolar origin:
    • Representing a unique group of neoplasms and cysts
• The various anatomic sites within the oral cavity as described by the American Joint Committee on Cancer (AJCC) and International Union Against Cancer (UICC) staging system are shown below:

• More than 90% of malignant tumors in the oral cavity are:
  • Squamous cell carcinomas:
    • The remainder are:
      • Minor salivary gland carcinomas and other rare tumors
• Most patients with cancer in the oral cavity are men:
  • Although the incidence of tongue cancer in women in the United States has progressively increased over the past several decades
• In the Western world:
  • The tongue (> 50% of cases) and floor of the mouth:
    • Are the most common sites of origin for primary squamous cell carcinomas in the oral cavity:
      • However, the retromolar trigone and buccal mucosa:
        • Are the most frequently encountered primary sites in areas of the world where chewing of tobacco and / or betel nuts is common
• The site distribution of various primary cancers in the oral cavity in the United States is shown bowls:

#Arrangoiz #Doctor #Surgeon #CancerSurgeon #HeadandNeckSurgeon #SurgicalOncologist #ThyroidSurgeon #ParathyroidSurgeon #BramanComprehensiveCancerCenter #BCCC #MountSinaiMedicalCenter #MSMC #Miami #Mexico

– The retromolar trigone (RMT) is a small triangular shaped subsite of the oral cavity:

• It is the portion of mucosa that lies behind the third inferior molar tooth:

  • Covering the anterior ramus of the mandible

• The base of the triangle:

  • Is posterior to the last inferior molar tooth (3rd)

• The apex is in continuity with the tuberosity of the maxilla:

  • Behind the last upper molar tooth

• It is bounded laterally by the gingival buccal sulcus and medially by the anterior tonsillar pillar

– Cancerous lesions involving the RMT are almost always squamous cell carcinomas (SCC):

• Minor salivary gland tumors:

  • Are sometimes diagnosed in this subset

• Because of its continuity with the oral cavity mucosa and its close relation to the mandible:

  • Spreading to adjacent structures can easily occur

  • Because squamous cell carcinoma of the retromolar trigone results in bone infiltration:

    • Lymph node metastasis and infiltration to the infratemporal fossa in the early stages is common:

      • Its prognosis is poorer than that of squamous cell carcinoma in neighboring areas:

        • Such as the tonsils, oral floor and gums

#Arrangoiz #Doctor #Surgeon #CancerSurgeon #SurgicalOncologist #HedandNeckSurgeon #MountSinaiMedicalCenter #MSMC #BramanComprehensiveCancerCenter #BCCC #Miami #Mexico

– The goals of treatment of cancer of the oral cavity are:

• Cure of the cancer

• Preservation or restoration of:

  • Speech, mastication, swallowing, and external appearance

• Minimization of the sequelae of treatment such as:

  • Dental decay, osteonecrosis of the mandible, and trismus

• Awareness of the risk of subsequent primary tumors and their management

– Surgery and radiotherapy can be used as a single modality or in combination for the treatment of cancer of the oral cavity

– Treatment Approaches:

• In general, early-stage (stage I or II) head and neck tumors:

  • May be treated using a single modality (surgery or radiotherapy):

    • Whereas advanced disease (stage III or IV) frequently benefits from multimodality therapy

  • The best therapeutic approach for the primary tumor depends on the anatomic site

  • Most neck disease can be treated equally well with surgery or radiation:

    • Thus the modality chosen to treat the neck is based on which modality is selected for the primary

  • When the primary tumor is treated with irradiation:

    • The regional lymphatics “at-risk” are incorporated into the treatment fields

  • Neck dissections should remain standardized (ie, complete anatomic dissections, as opposed to “berry picking” or random biopsy) in these settings to avoid incomplete surgery

Rodrigo ArrangoizSinai Medical Center in Miami, Florida:

He is first author on some publications on oral cavity cancer:

• Oral Tongue Cancer: Literature Review and Current Management 

  • https://www.oatext.com/pdf/CRR-2-153.pdf

• Understand Cancer: Research and Treatment Oral Cavity Cancer: Literature Review and Current Management. 

  • https://www.researchgate.net/publication/303366031_Understand_Cancer_Research_and_Treatment_Oral_Cavity_Cancer_Literature_Review_and_Current_Management

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Doctor #Surgeon #ComplexSurgicalOncologist

#HeadandNeckSurgeon

#CancerSurgeon

#BramanComprehensiveCancerCenter #BCCC

#MountSinaiMedicalCenter #MSMC

#Miami #Mexico

• In general, small and superficial tumors of the oral cavity:
  • Are equally amenable to being cured by:
    • Surgical resection or radiotherapy
• Therefore use of a single modality:
  • Is preferred as the definitive treatment in:
    • Early stage (T1 and T2) tumors of the oral cavity
• When the end point of treatment:
  • That is, cure of cancer:
    • Is comparable:
      • Other factors must play a role in the selection of initial treatment
      • These factors include:
        • Complications
        • Cost
        • Convenience
        • Compliance
        • Long-term sequelae of treatment
• Considering these factors:
  • Surgery:
    • Is the preferred treatment for T1 and T2 tumors of the oral cavity

The goals of treatment of cancer of the oral cavity are:

• Cure of the cancer

• Preservation or restoration of:

  • Speech, mastication, swallowing, and external appearance

• Minimization of the sequelae of treatment such as:

  • Dental decay, osteonecrosis of the mandible, and trismus

• Awareness of the risk of subsequent primary tumors and their management

Jatin P. Shah, Snehal G. Patel & Bhuvanesh Singh. “Jatin Shah’s Head and Neck Surgery and Oncology.” Apple Books. https://itunes.apple.com/us/book/jatin-shahs-head-and-neck-surgery-and-oncology/id535088692?mt=11

 Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon and is a member of the Braman Comprehensive Cancer at Mount Sinai Medical Center in Miami, Florida.

He is first author on some publications on oral cavity cancer:

• Oral Tongue Cancer: Literature Review and Current Management

  • https://www.oatext.com/pdf/CRR-2-153.pdf

• Understand Cancer: Research and Treatment Oral Cavity Cancer: Literature Review and Current Management.

  • https://www.researchgate.net/publication/303366031_Understand_Cancer_Research_and_Treatment_Oral_Cavity_Cancer_Literature_Review_and_Current_Management

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

• The goals of treatment of cancer of the oral cavity are:
  • Cure of the cancer
  • Preservation or restoration of:
    • Speech
    • Mastication
    • Swallowing
    • External appearance
  • Minimization of the sequelae of treatment such as:
    • Dental decay
    • Osteonecrosis of the mandible
    • Trismus
  • Selecting options with the awareness of the risk of subsequent primary tumors and their management
• Factors that influence the choice of initial treatment for oral cavity cancers are related to:
  • The characteristics of the primary tumor (tumor factors)
  • The patient (patient factors)
  • The treatment team (physician factors)

• The intercostobrachial nerve:
  • This nerve is a cutaneous branch of the intercostal nerves:
    • Most commonly the second intercostal nerve:
      • Which gives off a lateral cutaneous nerve:
        • Which continues as the intercostobrachial nerve
    • The intercostal nerves arise from the anterior rami of the thoracic spinal nerves
  • The intercostobrachial nerve pierces the serratus anterior:
    • Crosses the axilla to the medial side of the upper arm
  • The intercostobrachial nerve is commonly in the surgical field during axillary lymph node dissections:
    • It may be severed during surgery, or subject to traction or postsurgical inflammation:
      • Thus leading to intercostobrachial neuralgia
  • The larger intercostal nerves:
    • Can be preserved with meticulous dissection
• Neuropathic symptoms:
  • May be limited to numbness or tingling:
    • But may also include a burning sensation
• Techniques such as a regional nerve block have been described to alleviate symptoms in severe cases:
  • In a study of 200 patients who underwent axillary dissection:
    • 76% had symptoms of intercostobrachial neuralgia postoperatively
    • Of these patients, 82% reported improvement or resolution of these symptoms within 1 year:
      • Reflecting the richness of the sensory nerve supply to the axilla and upper arm
• The thoracodorsal nerve:
  • Is a branch of the posterior cord of the brachial plexus:
    • Supplies motor function to the latissimus dorsi
  • If injured:
    • Patients experience weakness with arm abduction, lateral flexion, and difficulty with activities such as climbing, swimming, and using the arms to pull the body up
• The medial cord of the brachial plexus:
  • Gives rise to the medial pectoral nerve:
    • Which innervates both the pectoralis minor muscle and the pectoralis major muscle
  • The medial pectoral nerve typically pierces the pectoralis minor muscle:
    • But may wrap around the lateral aspect of the pectoralis minor before traveling on to innervate the distal pectoralis major muscle
• The lateral cord of the brachial plexus:
  • Gives rise to the lateral pectoral nerve:
    • Which innervates the pectoralis major muscle
  • This nerve travels along the medial border of the pectoralis minor muscle, and then along the undersurface of the pectoralis major muscle along with the pectoral branch of the thoracoacromial artery to supply the proximal pectoralis major muscle
• The medial pectoral nerve bundle:
  • Is often encountered during axillary dissection as it is located lateral to the lateral pectoral nerve
• If either of these nerves is injured:
  • Pectoralis muscle atrophy can occur:
    • Which can present as a late complication of surgery:
      • With weakness of shoulder adduction, interior rotation, and flexion
• The long thoracic nerve:
  • Typically arises from anterior rami of the cervical spinal nerve roots C5 to C7:
    • It courses along the chest wall and supplies the serratus anterior muscle
  • Injury to this nerve causes a winged scapula
• References
  • Sclafani LM, Baron RH. Sentinel lymph node biopsy and axillary dissection: added morbidity of the arm, shoulder and chest wall after mastectomy and reconstruction. Cancer J. 2008;14(4):216-222.
  • Wisotzky EM, Saini V, Kao C. Ultrasound-guided intercostobrachial nerve block for intercostobrachial neuralgia in breast cancer patients: a case series. Prev Med Rep, 2016;8(3):273-277.
  • Roses DF, Brooks AD, Harris MN, Shapiro RL, Mitnick J. Complications of level I and II axillary dissection in the treatment of carcinoma of the breast. Ann Sur. 1999;230(2):194-201.
  • Porzionato A, Macchi V, Stecco C, Loukas M, Tubbs RS, De Caro R. Surgical anatomy of the pectoral nerves and the pectoral musculature. Clin Anat. 2012;25(5):559-575.

• Intercostobrachial nerve:
  • This nerve is a cutaneous branch of the intercostal nerves:
    • Most commonly the second intercostal nerve:
      • Which gives off a lateral cutaneous nerve:
        • Which continues as the intercostobrachial nerve
  • The intercostal nerves arise from:
    • The anterior rami of the thoracic spinal nerves
  • The intercostobrachial nerve pierces the serratus anterior:
    • Crosses the axilla to the medial side of the upper arm
  • The intercostobrachial nerve is commonly in the surgical field during axillary lymph node dissections and may be severed during surgery, or subject to traction or postsurgical inflammation:
    • Thus leading to intercostobrachial neuralgia
• The larger intercostal nerves:
  • Can be preserved with meticulous dissection
• Neuropathic symptoms:
  • May be limited to numbness or tingling:
    • But may also include a burning sensation
• Techniques such as a regional nerve block:
  • Have been described to alleviate symptoms in severe cases
• In a study of 200 patients who underwent axillary dissection:
  • 76% had symptoms of intercostobrachial neuralgia postoperatively
  • Of these patients, 82% reported improvement or resolution of these symptoms within 1 year:
    • Reflecting the richness of the sensory nerve supply to the axilla and upper arm
• The thoracodorsal nerve:
  • Is a branch of the posterior cord of the brachial plexus:
    • It supplies motor function to the latissimus dorsi
  • If injured, patients experience weakness with arm abduction, lateral flexion, and difficulty with activities such as climbing, swimming, and using the arms to pull the body up
• The medial cord of the brachial plexus:
• Gives rise to the medial pectoral nerve:
  • Which innervates both the pectoralis minor muscle and the pectoralis major muscle
• The medial pectoral nerve typically pierces the pectoralis minor muscle:
  • But may wrap around the lateral aspect of the pectoralis minor before traveling on to innervate the distal pectoralis major muscle
• The lateral cord of the brachial plexus:
  • Gives rise to the lateral pectoral nerve:
    • Which innervates the pectoralis major muscle
  • This nerve travels along the medial border of the pectoralis minor muscle:
    • Then along the undersurface of the pectoralis major muscle along with the pectoral branch of the thoracoacromial artery to supply the proximal pectoralis major muscle
• The medial pectoral nerve bundle:
  • Is often encountered during axillary dissection as it is located lateral to the lateral pectoral nerve
• If either of these nerves is injured:
  • Pectoralis muscle atrophy can occur:
    • Which can present as a late complication of surgery, with weakness of shoulder adduction, interior rotation, and flexion
• The long thoracic nerve:
  • Typically arises from anterior rami of the cervical spinal nerve roots C5 to C7
  • It courses along the chest wall and supplies the serratus anterior muscle
  • Injury to this nerve causes a winged scapula
• References:
  • Sclafani LM, Baron RH. Sentinel lymph node biopsy and axillary dissection: added morbidity of the arm, shoulder and chest wall after mastectomy and reconstruction. Cancer J. 2008;14(4):216-222.
  • Wisotzky EM, Saini V, Kao C. Ultrasound-guided intercostobrachial nerve block for intercostobrachial neuralgia in breast cancer patients: a case series. Prev Med Rep, 2016;8(3):273-277.
  • Roses DF, Brooks AD, Harris MN, Shapiro RL, Mitnick J. Complications of level I and II axillary dissection in the treatment of carcinoma of the breast. Ann Sur. 1999;230(2):194-201.
  • Porzionato A, Macchi V, Stecco C, Loukas M, Tubbs RS, De Caro R. Surgical anatomy of the pectoral nerves and the pectoral musculature. Clin Anat. 2012;25(5):559-575.

• It is a surgical sub-specialty that deals mainly with benign and malignant tumors of the head and neck region, including:
  • The scalp, facial region, eyes, ears, nose, nasal fossae, paranasal sinuses, oral cavity, pharynx (nasopharynx, oropharynx, hypopharynx), larynx (supraglotic larynx, glottis larynx, subglotic larynx), thyroid gland, parathyroid gland, salivary glands (parotid glands, submandibular glands, sublingual glands, minor salivary glands), soft tissues of the neck, skin of the head and neck region.
• The head and neck surgeon’s work area:
  • Does not cover tumors or diseases of the brain and other areas of the central nervous system or those of the cervical spine:
    • This is the neurosurgeon field
• Among the diagnostic procedures performed by the head and neck surgeon, are the following:
  • Nasopharyngolaryngoscopy:
    • Performed to examine, evaluate and, possibly perform a biopsy, of oral cavity, pharyngeal and laryngeal lesions
• The surgeries most commonly performed by the head and neck surgeon are:
  • Total or near total thyroidectomies
  • Hemithryoidectomies (lobectomies)
  • Comprehensive neck dissections
  • Selective neck dissections
  • Maxillectomies:
    • Total maxillectomy
    • Subtotal maxillectomy
    • Infrastructure maxillectomy
    • Suprastructure maxillectomy
    • Medial maxillectomy
  • Mandibulectomy:
    • Segmental
    • Marginal
  • Tracheostomy
  • Salivary gland surgeries:
    • Parotid gland operations:
      • Limited superficial parotidectomy with identification and preservation of the facial nerve
      • Superficial parotidectomy with identification and preservation of the facial nerve
      • Near total parotidectomy with identification and preservation of the facial nerve
      • Total parotidectomy
    • Submandibular gland resection
    • Sublingual gland resection
  • Resection of tumors of the oral cavity:
    • Glossectomy
    • Resection of the floor of the mouth tumors
  • Resection of tumors of the pharynx
  • Resection of tumors of the larynx
  • Split-thickness skin grafts
  • Full-thickness skin grafts
  • Sentinel lymph node mapping and sentinel lymph node biopsy
  • Resection of malignant skin tumors (BCC, SCC, melanoma) of the head and neck region
• The training of the head and neck surgeon includes mastering the following subjects:
  • Surgical Anatomy
  • History and Basic Principles of Head and Neck Surgery
  • Epidemiology, Etiology, and Pathology of Head and Neck Diseases
  • Diagnostic Radiology of the Head and Neck Region
  • Tumors of the Scalp, Skin and Melanoma
  • Eyelids and Orbit
  • Nasal Cavity and Paranasal Sinuses
  • Skull Base and Temporal Bone
  • Lips and Oral Cavity
  • Pharynx and Esophagus
  • Larynx and Trachea
  • Cervical Lymph Nodes
  • Thyroid and Parathyroid Glands
  • Salivary Glands
  • Neurogenic Tumors and Paragangliomas
  • Soft Tissue Tumors
  • Bone Tumors and Odontogenic Lesions
  • Reconstructive Surgery
  • Oncologic Dentistry and Maxillofacial Prosthetics
  • Principles of Radiation Oncology
  • Principles of Chemotherapy
  • Molecular Oncology, Genomics and Immunology
  • Nutrition
  • Biostatistic

My name is Rodrigo Arrangoiz I am a board-certified surgical oncologist who sub-specializes in breast cancer and head and neck cancer. I earned his medical degree at the Anahuac University Medical School in Mexico City, Mexico and graduated Suma Cum Laude. I completed his internship and residency in general surgery at Michigan State University, where he was named chief resident during his fifth year of residency. I also completed a complex surgical oncology, head and neck fellowship at the Fox Chase Cancer Center in Philadelphia and at the same time he undertook a master’s in science (Clinical Research for Health Care Professionals) at Drexel University in Philadelphia. I participated in a two-year global online fellowship in head and neck surgery and oncology through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center.

I have participated in multiple courses and academic congresses as a lecturer and guest professor and has also participated in several publications on topics related to his specialty that include oral cavity cancer, hyperparathyroidism, thyroid cancer, breast cancer, endocrine tumors, squamous cell carcinoma of the head and neck, and more. I am board certified by the American Board of Surgery, the Mexican Board of General Surgery and the Mexican Board of Oncology.

I am a member of various medical associations such as the American College of Surgeons, American Thyroid Association, American Head and Neck Society, American Medical Association, American Society of Clinical Oncology, Association of Academic Surgeons, Society of Surgical Oncology, among others.

https://www.msmc.com/doctor/rodrigo-arrangoiz/

#Arrangoiz #HeadandNeckSurgeon #CancerSurgeon #SurgicalOncologist #MountSinaiMedicalCenter #MSMC #Mexico #Miami #ThyroidSurgeon #ParathyroidSurgeon

What is Head and Neck Surgery?

What You Need to Know About Head and Neck Cancer Treatments That Provide Life-Saving Results

By Dr. Rodrigo Arrangoiz, MS, MD, FACS, FSSO – Surgical Oncologist, Mount Sinai Medical Center

From the way we speak and eat to how we breathe and express emotions, the head and neck region plays a vital role in daily life. Unfortunately, this complex area is also susceptible to a variety of cancers that can dramatically affect a person’s health and quality of life. That’s why understanding head and neck cancers—their risk factors, symptoms, and treatment options—is critical for early detection and successful outcomes.

As a surgical oncologist specializing in head and neck and breast cancers at Mount Sinai Medical Center, I’ve seen firsthand how early diagnosis and expert care can be lifesaving. During Head and Neck Cancer Awareness Month, I want to share what patients and families should know.

What Is Head and Neck Cancer?

Head and neck cancer is not a single disease but a group of biologically similar cancers that begin in the squamous cells lining the mucosal surfaces inside the head and neck—such as the mouth, throat, and voice box. Cancers can also arise in the salivary glands, thyroid, sinuses, or skin of the face and scalp.

According to the National Cancer Institute, over 72,000 Americans will be diagnosed with a head and neck cancer in 2025 alone. These cases often involve complex anatomy and require a multidisciplinary approach to treatment.

Risk Factors You Should Know

Several risk factors are strongly linked to head and neck cancers:

Tobacco and alcohol use: These remain the leading causes, especially when combined. Human papillomavirus (HPV): HPV is now the leading cause of oropharyngeal cancers, particularly in younger, non-smoking patients. Sun exposure: Prolonged UV exposure increases the risk of skin cancers in the facial and scalp areas. Poor oral hygiene, poor nutrition, and exposure to certain industrial chemicals also contribute to overall risk.

Know the Signs—And Speak Up

Symptoms can be subtle. If you notice persistent hoarseness, difficulty swallowing, a lump in the neck, or an unusual growth in the mouth or throat, don’t delay—get evaluated by your primary care physician. You may be referred to a head and neck surgical oncologist for further testing.

Early detection makes a difference. Many head and neck cancers are curable when caught in the early stages.

The Role of Surgery in Head and Neck Cancer Treatment

As a surgical oncologist, my role involves diagnosing and surgically treating tumors in the head and neck region—both benign and malignant. Surgery can be curative, especially when paired with other therapies like radiation or chemotherapy.

Common conditions and procedures we manage include:

Thyroid and parathyroid surgery for cancer or overactivity Salivary gland tumor removal (parotid, submandibular) Lymph node dissections in the neck for cancer staging or treatment Mouth and throat tumor resections, sometimes involving the tongue or larynx Skin cancer excisions and facial reconstruction Advanced reconstructive surgery using microvascular techniques when necessary

Each patient receives a personalized plan based on the tumor type, location, stage, and overall health. At Mount Sinai’s Comprehensive Cancer Center, we combine advanced surgical techniques with cutting-edge diagnostics, targeted therapies, and compassionate, team-based care.

Expertise at Mount Sinai Medical Center

Mount Sinai’s Comprehensive Cancer Center is one of South Florida’s leading institutions for head and neck cancer care. We offer:

State-of-the-art imaging and biopsy services A multidisciplinary tumor board to tailor treatment plans Access to clinical trials and the latest medical advancements Reconstructive surgery expertise for functional and cosmetic outcomes Post-treatment rehabilitation, including speech and swallowing therapy

Our goal is to not only treat the cancer but also preserve quality of life—whether that’s helping a patient regain their voice, their smile, or their confidence.

About Dr. Rodrigo Arrangoiz

Dr. Rodrigo Arrangoiz is a board-certified surgical oncologist with specialized fellowship training in complex head and neck surgery and breast surgical oncology. He is a Fellow of the American College of Surgeons (FACS) and the Society of Surgical Oncology (FSSO). He completed his advanced training at some of the most prestigious cancer centers in the U.S. and currently practices at Mount Sinai Medical Center in Miami Beach, where he provides cutting-edge, compassionate cancer care.

To learn more about Mount Sinai’s Comprehensive Cancer Center, visit:

msmc.com/comprehensive-cancer-center