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Surgery of oral cancer

Small tumors (T1–2)

Small tumors are removed either by scalpel or CO2 laser. The specimen is then labeled thoroughly. Margins of resection are checked with frozen section to ensure complete removal of cancer.

For resection margins on the lower jaw, bone must not be exposed due to the danger of osteoradionecrosis (10). If the bone cannot be covered with primary sutures of the mucosa, a skin graft or nasolabial flap is often used for coverage. This is docked after 3-4 weeks. Indications for post-operative radiation therapy include close or positive resection margins, perineural invasion, lymphovascular invasion, lymph node metastases (usually more than 1), extracapsular spread, or sometimes T4 tumor.

Larger tumors

Status after reconstruction of the left part of the tongue and floor of the mouth with a pectoral myocutaneous flap. 

Skin/muscle flaps or free grafts allow for larger resections (5).

Excision of larger tumors often leads to a considerable defect in the mucosa and soft tissue and/or bone of the upper and lower jaw. Defects can be covered/replaced with a myocutaneous flap or skin flap. Free flaps are used increasingly to replace mucosa and bone grafts (fibula) for replacement of the lower jaw. 

Pectoral flap

Muscle covered by skin is dissected with a vessel pedicle from the thoracic wall. The skin muscle flap is then pulled up under the skin on the neck to the area requiring replacement of volume due to excision of soft tissue and skin coverage for replacement of mucosa.

Deltopectoral flap

Skin and subcutaneous tissue from the shoulder with a vessel pedicle is dissected and pulled up to the area to be covered.

Deltopectoral skin flap used to cover a defect on the skin of the neck. 

Surgery for tumors in the mouth is often combined with cervical lymphadenectomy. This is done therapeutically in cases of confirmed metastases, or prophylactic in cases where there is no suspected spreading to the cervical nodes, and to provide space for the skin/muscle flap.

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