Download 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 )
• 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
TNM Staging
T
N
M
Stage IVC
Operation done
• Wide excision of the ulcer with segmental
mandibulectomy with modified radical neck
dissection, left: the defect was reconstructed
using titanium plates.
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.
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• Advantages
– Adequate margins of resection
– Excellent exposure
– Ease of exposure
• Disadvantages
• Cosmetic and functional consequences
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
5. What adjuvant treatment is
required
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
Chemotherapy
• No survival advantage compared to surgery
and/or radiation
– Cisplatin, carboplatin, 5-FU
• Palliation of recurrent or unresectable disease,
combined with radiation