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Oral cancer

Surgery for oral cancer

Depending on the stage of oral cancer, your doctor may recommend one or more of the following procedures:

Tumor resection: In this operation to remove the entire tumor, some normal tissue surrounding the tumor is also removed in an attempt to eradicate as many cancer cells as possible. A small tumor that is easily reached may often be removed through the mouth. For tumors that are larger or harder to reach, an incision may be required in the neck or jawbone.

Mohs micrographic surgery: This surgical oncology procedure, also known simply as micrographic surgery, may be recommended for some cancers of the lip. With this approach, a tumor is removed in very thin slices, with each slice examined under the microscope for the presence of cancer cells. The process continues until no cancer cells are seen. This gradual approach helps prevent the removal of normal tissue, as well as some changes in appearance.

Full or partial mandible (jawbone) resection: When a tumor has grown into the jawbone, a mandibular resection, or mandibulectomy, may be needed. In this procedure, all or part of the jawbone is removed. If the jawbone appears normal in an X-ray and no other evidence of cancer cells is found in the area, just a small piece of the bone may be removed. However, if the X-ray shows cancer in the jawbone, then the entire bone may need to be removed.

Glossectomy: This type of cancer surgery, which involves removal of the tongue, is used to treat cancers of the tongue. When a tumor is very small, only partial removal may be necessary. Larger tumors may require removal of the entire tongue.

Maxillectomy: This operation removes all or part (partial maxillectomy) of the hard palate, the front of the roof of the mouth. A special denture may be created to fill the hole left by this surgery. Your doctor will likely refer you to a prosthodontist, a specialized dentist, to make a prosthetic tailored to your mouth.

Laryngectomy: This surgical oncology procedure involves removing the voice box along with the primary tumor. When a large tumor has grown on the tongue or in the oropharynx, it may be necessary to remove some tissue involved in swallowing to remove as many cancer cells as possible. As a result of this process, food may enter the windpipe (trachea) and then the lungs, which may cause pneumonia. When the risk of pneumonia is high, a laryngectomy may be recommended. With this procedure, the windpipe is attached to a hole in the skin of the neck for breathing. A laryngectomy does not always leave the patient unable to talk. Several techniques are available in some circumstances to restore vocal capabilities after a laryngectomy.

Neck dissection: This type of oral cancer surgery is used to remove lymph nodes in the neck if cancer has spread to this area. Depending on the size and extent of cancer in the lymph nodes, different procedures are recommended, among them:

    • Partial or selective neck dissection to remove only a few lymph nodes
    • Modified radical neck dissection to remove most lymph nodes on one side of the neck between the jawbone and collarbone, along with some muscle and nerve tissue
    • Radical neck dissection to remove almost all lymph nodes on one side, with more extensive removal of muscle, nerves, and veins

Other surgical oncology procedures for oral cancer include:

Pedicle or free flap reconstruction: When a large tumor is removed, the mouth, throat or neck may require repair of some kind. Sometimes, a skin graft may be performed. In this instance, a thin slice of skin is removed from the thigh and reattached in the oral cavity area in need of repair. When the defect is larger, a piece of muscle, with or without skin, may be shifted from a nearby area, such as the chest or upper part of the back.

Microsurgery: Advances in microvascular surgery, which involves attaching blood vessels under a microscope, have led to improvements in reconstructing the oral cavity and oropharynx. These techniques mean that tissue from distant parts of the body, such as the intestine, arm muscle, abdominal muscle, or even lower leg bone, may be used to replace parts of the mouth, throat or jawbone.

Tracheostomy: If a tumor in the oropharynx is too large to remove completely, a hole may be opened in the windpipe and front of the neck to allow for comfortable breathing. Sometimes, removing a tumor may lead to extensive swelling in the neck. In this case, your surgical oncology team may perform a temporary tracheostomy, in which an incision is made in the trachea, to ease breathing until the swelling goes down.

Gastrostomy tube: A gastrostomy tube is a feeding tube sometimes inserted directly into the stomach. This approach may be recommended if a cancer in the oral cavity or oropharynx is preventing swallowing. A gastrostomy tube may help the patient receive adequate nutrition. A feeding tube may also be placed in the stomach through the mouth. In this process, known as a percutaneous endoscopic gastrostomy, or PEG, a camera is attached to the end of a long, thin tube, allowing the doctor to see directly into the stomach. Special liquid nutrients may be provided through the tube. These tubes may be inserted on a short-term or long-term basis. They can help keep you healthy and fed during treatment, and may be left in after treatment if necessary. The tube may be easily removed as soon as normal eating is possible.

Dental extraction and implants: When radiation is used to treat oral cancer, it may be necessary to remove teeth, because exposure of unhealthy teeth to radiation may lead to serious problems. A complete dental evaluation is always performed for patients receiving radiation therapy for oral cancer. If your surgical oncology team removes your jawbone and reconstructs it using bone from another part of the body, dental implants may be placed in the new bone. These implants are hardware that prosthetic teeth can attach to, either during reconstructive surgery or later.