Abstract
BackgroundThe aim of oral cancer surgery is tumor removal within clear margins of healthy tissue: the latter definition in the literature, however, may vary between 1 and 2 cm, and should be intended in the three dimensions, which further complicates its precise measurement. Moreover, the biological behavior of tongue and floor of mouth cancer can be unpredictable and often eludes the previously mentioned safe surgical margins concept due to the complexity of tongue anatomy, the intricated arrangements of its intrinsic and extrinsic muscle fibers, and the presence of rich neurovascular and lymphatic networks within it. These structures may act as specific pathways of loco-regional tumor spread, allowing the neoplasm to escape beyond its visible macroscopic boundaries. Based on this concept, in the past two decades, compartmental surgery (CS) for treatment of oral tongue and floor of mouth cancer was proposed as an alternative to more traditional transoral resections.MethodsThe authors performed three anatomical dissections on fresh-frozen cadaver heads that were injected with red and blue-stained silicon. All procedures were documented by photographs taken with a professional reflex digital camera.ResultsOne of these step-by-step cadaver dissections is herein reported, detailing the pivotal points of CS with the aim to share this procedure at benefit of the youngest surgeons.ConclusionsWe herein present the CS step-by-step technique to highlight its potential in improving loco-regional control by checking all possible routes of tumor spread. Correct identification of the anatomical space between tumor and nodes (T-N tract), spatial relationships of extrinsic tongue muscles, as well as neurovascular bundles of the floor of mouth, are depicted to improve knowledge of this complex anatomical area.
Highlights
Compartmental surgery (CS) has emerged in the last decade as a promising approach for treatment of locally advanced cancers of the tongue and floor of mouth
If mandibulotomy is needed to reach tumors with massive posterior tongue involvement or associated trismus, skin incision can be modified by extending it to the mandibular symphysis and lower vermilion (Figure 1, dotted line)
A subplatismal cervical flap is raised with exposure of the body of the mandible, paying attention to preserve the mandibularis branch of the VII cranial nerve which runs in a plane deep to the superficial cervical fascia
Summary
Compartmental surgery (CS) has emerged in the last decade as a promising approach for treatment of locally advanced cancers of the tongue and floor of mouth. First conceived and proposed by Calabrese and coworkers in 2009, CS allows better oncological outcomes compared to traditional wide-margin (1-2 cm) resections, in terms of both local and locoregional control [3, 4] This standardized technique involves the enbloc resection of one hemitongue and related floor of mouth via pull-through or transmandibular approaches, clearing the neck lymph nodes in continuity with the “tumor-nodes” (T-N) tract. The biological behavior of tongue and floor of mouth cancer can be unpredictable and often eludes the previously mentioned safe surgical margins concept due to the complexity of tongue anatomy, the intricated arrangements of its intrinsic and extrinsic muscle fibers, and the presence of rich neurovascular and lymphatic networks within it These structures may act as specific pathways of loco-regional tumor spread, allowing the neoplasm to escape beyond its visible macroscopic boundaries. In the past two decades, compartmental surgery (CS) for treatment of oral tongue and floor of mouth cancer was proposed as an alternative to more traditional transoral resections
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
