Oral Cavity and Neck Dissection

Abstract

Cancer of the oral cavity is one of the most common malignancies, especially in developing countries but also in the developed world. Squamous cell carcinoma (SCC) is the most common histology, and the main etiological factors are tobacco and alcohol use. Although early diagnosis is relatively easy, presentation with advanced disease is not uncommon. The standard of care is primary surgical resection with or without postoperative adjuvant therapy. Surgery remains the mainstay for nearly all tumours of the oral cavity. On the other hand, non-surgical approaches have shown equally effective tumour control and better functional outcomes in selected patients with tumours of the oropharynx. Multiple surgical approaches have been described for resection of primary oral cavity tumours, including peroral, mandibulotomy, lower cheek flap, visor flap and upper cheek flap approaches. The selection of a particular approach depends on several factors, including the tumour size and site, depth of infiltration and proximity to the mandible or maxilla. The principles of an adequate oncological resection should not be compromised by efforts to minimise the extent of the procedure. Improvements in surgical techniques combined with the routine use of postoperative radiation or chemoradiation therapy have resulted in improved survival statistics over the past decade. Successful treatment of patients with oral cancer is predicated on multidisciplinary treatment strategies to maximise oncologic control and minimise the impact of therapy on form and function.