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4. What type of surgery is indicated?

4. What type of surgery is indicated?. Operative findings:. 3 x 2 cm ulcer of the lower gingiva with invasion into the mandible 5 x 4 cm well-encapsulated firm mass located at the submandibular triangle (level 1 to level 2 )

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4. What type of surgery is indicated?

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  1. 4. What type of surgery is indicated?

  2. Operative findings: • 3 x 2 cm ulcer of the lower gingiva with invasion into the mandible • 5 x 4 cm well-encapsulated firm mass located at the submandibular triangle (level 1 to level 2 ) • Multiple pinkish-red, firm, grossly enlarged nodes (1-2 cm) along the jugular chain (levels 2 to 4) • 4 x 3 cm well encapsulated firm mass at the subclavicular area

  3. TNM Staging T N M

  4. Stage IVA

  5. Operation done • Wide excision of the ulcer with segmental mandibulectomy with modified radical neck dissection, left: the defect was reconstructed using titanium plates.

  6. Segmental Mandibulectomy • removes an entire segment of the mandible, disrupting continuity of the bone.  This is performed when tumor invades bone. • may be performed in the setting of a composite resection, • resection of a segment of mandible in continuity with a cancer of the oral cavity or oropharynx or a primary cancer of the alveolar ridge. http://www.expertconsultbook.com/expertconsult/ob/book.do?method=display&type=bookPage&decorator=none&eid=4-u1.0-B978-1-4160-2445-3..50037-6&isbn=978-1-4160-2445-3

  7. Advantages • Adequate margins of resection • Excellent exposure • Ease of exposure • Disadvantages • Cosmetic and functional consequences

  8. Final histopath: • Well differentiated squamous cell carcinoma with metastasis to 5/20 lymph nodes, the largest measures 2 cm with extracapsular invasion; margins clear; with bony invasion

  9. 5. What adjuvant treatment is required

  10. Radiation • Pre and post-op radiation • Improves local/regional control in HNSCC • within 6 weeks of surgery • 50 to 70 Gy over 5 to 7 weeks • Adverse reactions: • acute: mucositis, skin erythema • Late: fibrosis, xerostomia, altered state

  11. Chemotherapy • No survival advantage compared to surgery and/or radiation • Cisplatin, carboplatin, 5-FU • Palliation of recurrent or unresectable disease, combined with radiation

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