Surgical Management Of Oral Cancer Research Articles

Surgical management of oral cancer extending to the pterygoid region

The resection of oral cancers extending into the pterygoid region remain a challenge for head and neck surgeons. Few studies have suggested the approach methods and showed that the tumor can be resected with a clear vision. In this case series study, we advocated a surgical method for the tumor ablation surgery over this region. The study was conducted in 11 patients with tumors near or directly invading into the pterygoid regions. A cheek flap combined with ramus removal was used to approach the pterygoid plates and the associated muscles. A reciprocating saw was used subsequently for the pterygoid plate resection. In the collected 11 patients, neither serious complications occurred during the surgery nor immediate complications happened after the surgery. Four patients expired during the postoperative follow-up period. Two of them died of cancer related conditions, one for tumor recurrence and the other for distant metastasis. The reasons for non-cancer specific mortality were myocardial infraction and aspiration pneumonia Only one patient showed positive margins in the final surgical pathology.

Optical fluorescence imaging in oral cancer and potentially malignant disorders: A systematic review.

This study aimed to systematically review the efficacy of direct optical fluorescence imaging as an adjunct to comprehensive oral examination in the clinical evaluation, risk assessment and surgical management of oral cancer and potentially malignant disorders. Studies adopting autofluorescence devices, evaluating the efficacy of comprehensive oral examination and optical fluorescence imaging in detection, visualisation or management of oral squamous cell carcinoma or oral potentially malignant disorders, as well as discriminating oral epithelial dysplasia from other mucosal lesions, were included in the literature search across bibliographic databases until October 2018. Twenty-seven studies were found to be eligible for inclusion in qualitative analysis. Of these, only six studies demonstrated a low risk of bias across all domains of the methodological assessment tool (QUADAS-2). Optical fluorescence imaging demonstrated positive results, with higher sensitivity scores, increased lesion detection and visualisation than comprehensive oral examination alone in the clinical evaluation of oral squamous cell carcinoma and oral potentially malignant disorders. This review provides promising evidence for the utilisation of optical fluorescence imaging as an adjunct to comprehensive oral examination in varying clinical settings. It is important that devices utilising optical fluorescence imaging are viewed strictly as clinical adjuncts and not specifically as diagnostic devices.

Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.

Effectiveness of pectoralis major myocutaneous flap in the surgical management of oral cancer: A retrospective study

IntroductionOver 80,000 oral cancer cases get diagnosed each year in India, majority undergoing extensive resections owing to their late presentation. Pectoralis major myocutaneous (PMMC) flap is a pedicled axial pattern flap which is based on thoracoacromical artery. It is readily available as a viable alternative to free flap reconstruction, especially for the economically poor and malnourished patients. Its proximity to head and neck structures gives added advantage to reconstruct complex and large volume oral and maxillofacial defects. It provides a relatively good possibility of functional and aesthetic restoration providing both mucosal lining and skin cover. Materials and methodsThis was a prospective observational study of 29 PMMC flap reconstructions, conducted between 2013–2016. The reconstruction outcomes assessed in this study were divided into two categories namely “success” and “failure” based on certain functional parameters observed during follow-up of 1 year. The complications were broadly classified as major/minor and flap related/non-flap related. We assessed the feasibility of using a PMMC flap for reconstructing various subsites of oral cavity cancer. Further, the association of patient variables with complication rates and outcome of reconstruction were analysed. ResultsOut of 29 patients overall complications were noted in 15 (51.7%) cases with a female preponderance. Flap-related complications were noted in 9 whereas non-flap-related complications were seen in 6 patients. Major and minor complications were noted in 2 (both flap related) and 13 cases respectively. Complete full thickness flap necrosis was not encountered in any patient. Patients with flap skin paddle size ≤ 36 cm2 (n = 12) had significantly increased overall complication rates. Despite complications a high success rate (93.1%, n = 27) was achieved with this mode of reconstruction. ConclusionThe PMMC flap reconstruction is a versatile, reliable and an affordable single staged procedure with a high success rate in terms of achieving treatment goals. Although it has moderately high complication rates, but PMMC flap proved to be a workhorse in locally advanced cases of head and neck cancer at the end of 1 year follow-up.

Cervicofacial-facial artery myocutaneous flap (C-FAM flap): A novel flap in oral cavity reconstruction.

Reconstruction is an integral part of the surgical management of oral cancer. Local flaps are one of the options in reconstruction of small to moderate sized defects of oral cavity. Reconstruction is an integral part of the surgical management of oral cancer. Every defect needs to be assessed individually to tailor made the reconstruction because of its multidimensionality and complexity. Varieties of autologous tissues are being used in reconstruction like local, regional, or free flaps which can be simple or complex tissues. There is always a trend to identify the newer flaps/technique to personalize reconstruction. Local flaps are also one of the options in reconstruction of small to moderate sized defects of oral cavity. Local tissue if it is available is in the primary surgeon's purview and the flap can be raised without much technical difficulty and morbidity. We used perforator based tissue from the face and neck which is richly supplied by the facial vessels and named as the Cervicofacial- Facial Artery Myocutaneous flap (C-FAM flap) for reconstruction of oral cavity. We used perforator based local tissue from the face and neck which is supplied by facial vessels and named it as the C-FAM flap for the reconstruction of oral cavity defects. Twenty-eight patients underwent C-FAM flap reconstruction in different subsites of the oral cavity with acceptable functional rehabilitation. There was no flap loss. The C-FAM flap is a robust flap, which is reliable, pliable, and rich in its vascularity. It has to be one of the armamentarium for the oral cavity reconstruction. C-FAM flap: A Novel flap in Oral cavity reconstruction.

Prosthetic rehabilitation of marginal mandibulectomized patient using implant-supported removable partial denture

Surgical management of oral cancer results in compromised masticatory and swallowing function which affects patient in social and psychological aspects due to reduced phonetic ability and facial deformity, thus, it is imperative to provide applicable prosthetic treatment to overcome such complications. This clinical study describes rehabilitation of a patient with squamous cell carcinoma treated with marginal mandibulectomy and implantation on preserved posterior portion of mandible to provide stability and support for subsequent denture treatment. Kennedy class IV removable partial denture has provided satisfactory results in esthetics and function. Bone level stability around implants was reported to be maintained during eight months of clinical observation. (J Korean Acad Prosthodont 2016;54:126-31)

10. Surgical management of oral cancer

10. Surgical management of oral cancer

Oral rehabilitation with dental implants after cancer treatment

Patients who undergo surgical management of oral cancer may greatly benefit from an implant-supported prosthesis. This study reports on the clinical experience of dental implant placement in patients following resection of oral cancer over a 15-year period. Controversies including the use of dental implants in irradiated tissues, and hyperbaric oxygen treatment will also be discussed. Thirty-one patients who had dental implants placed as part of their oral rehabilitation between 1992 and 2007 were investigated. Demographic data and factors including implant survival, type of prosthesis provided, radiotherapy and the hyperbaric oxygen therapy were analysed. In this retrospective study, there was a retention rate of 110 implants from a total of 115 implants placed. A high rate of implant retention was found, with 5 implant failures from a total of 115 implants placed. The 5 failed implants occurred in free flap bone that had been irradiated. Dental implants provide an important role in the oral rehabilitation of oral cancer patients. There may be an increased risk of implant failure in free flap bone that has been irradiated.

Surgical Management of Oral Cancer

Oral cancer is the sixth most common cancer worldwide. Treatment is directed at the elimination of the primary tumor and neck metastasis with minimal morbidity to the patients. Surgery is the most well established mode of initial definitive treatment for a majority of oral cancer. In spite of a significant paradigm shift in the treatment of many head and neck cancer toward using primary chemoradiation, this treatment is not frequently applied to the oral cavity. Small oral cancers are usually managed by surgery alone. Advanced oral cancers are usually treated with primary surgery followed by radiation. Primary site, location, size, proximity to bone, and depth of invasion are factors which influence a particular surgical approach.

Sentinel lymph node biopsy in oral squamous cell carcinoma: a systematic review and meta-analysis

The greatest contemporary dilemma in the surgical management of oral cancer remains whether or not to subject clinically N0 patients to an elective neck dissection. This systematic review aims to determine the acceptability of sentinel lymph node biopsy (SLNB) as the key influential factor in deciding on therapeutic intervention in such cases based on the procedure's feasibility, sensitivity and predictive ability. A systematic search of all literature available globally, employing pre-defined inclusion and exclusion criteria using electronic and manual search methods including personal communication was undertaken.

A comparison of tongue and soft palate squamous cell carcinoma treated by primary surgery in terms of survival and quality of life outcomes

In the surgical management of oral cancer the resection and reconstruction of the mobile tongue and soft palate are most important if function is to be maintained. The present trend towards primary laryngeal surgery for early disease has emphasized the importance of primary surgery if good functional outcomes can be achieved. This study compares the functional and health-related quality of life outcomes for primary surgery and reconstruction of the anterior tongue and soft palate. From a cohort of 566 patients treated from 1992 to 2002, 118 fitted the criteria for anterior tongue and 44 for soft palate resection. University of Washington Quality of Life scores were available in around three quarters of patients. In terms of speech and swallowing a 3/4 or total anterior glossectomy had a worse outcome than a 1/4 or 1/2. In patients having a 3/4 or total resection of the soft palate however, the results showed a similar outcome to those with 1/4 or 1/2 resection. The functional results of 3/4 and total soft palate reconstruction were superior to 3/4 and total anterior tongue resections and were similar to the whole cohort. This finding extends the role of functional surgery in the oropharynx for which primary radiotherapy is often preferred to preserve function.

Trends in surgical management of oral cancer; A 10 year Pakistan experience

Trends in surgical management of oral cancer; A 10 year Pakistan experience

The role of marginal mandibulectomy in the surgical management of oral cancer.

The role of marginal mandibulectomy in the surgical management of oral cancer.

The making of a specialty

The making of a specialty

The percutaneous dilatational tracheostomy in the surgical management of oral cancer

The percutaneous dilatational tracheostomy in the surgical management of oral cancer

Surgical management of oral cancer : Strong E. Dent Clin North Am 34:185, 1990

Surgical management of oral cancer : Strong E. Dent Clin North Am 34:185, 1990

Surgical Management of Oral Cancer

Oral cancer remains a challenge and a frustration to the clinician. If treated when the tumor is small and localized, at least 70% of patients can be cured. Results of treatment of early and moderate-sized oral cancers are satisfactory and gratifying with minimal cosmetic and functional disability in contrast to the results following treatment of massive oral cancers. Clearly, the importance of early detection and appropriate treatment while the lesion is still low stage cannot be overemphasized. Alternative treatments, including laser vaporization/resection and photodynamic therapy, are being increasingly investigated and their indications and contraindications defined. Increased knowledge of the intricacies of chemotherapy and immunotherapy and their use as definitive treatment combined with advances in radiation therapy, including hyperfractionated irradiation and use of high-energy particles, may improve the overall outlook. Meanwhile, surgical treatment remains a mainstay in the management of many of these patients. We must emphasize the importance of early diagnosis and in those unfortunate patients with advanced disease further investigated the most efficient and effective combined modality treatment together with expeditious and effective reconstruction. Prevention is the ultimate goal, but as yet our societal motivation and energies are not directed on these lines.