Frequently, a mandible resection is required in order to obtain safe oncologic margins. The prognosis is good, with a higher overall survival rate than in other oral malignancies. Keywords carcinoma, floor of the mouth, mandible resection, neck dissection Base of tongue cancer caused by hpv Cu o prevalenţă inferioară tumorilor maligne ale limbii, tumorile maligne de planşeu anterior impun o abordare chirurgicală la fel de radicală, cu o margine de siguranţă mare şi cu managementul problemelor de la nivelul gâtului.
Datorită localizării lor anterioare, sunt mai uşor de diagnosticat, iar pacientul se prezintă şi în stadii incipiente, nu doar în stadii tardive. Frecvent, este necesară rezecţia mandibulei, pentru a obţine margini de siguranţă oncologică.
Prognosticul este bun, cu o supravieţuire generală mai mare decât în cazul altor malignităţi orale. Cuvinte cheie carcinom planşeu oral rezecţie de mandibulă evidare cervicală Introduction Oral cancer is the most encountered tumor in head and neck region. It usually affects male patients in their 6th decade of life 1a possible explanation for this gender imbalance being related to smoking and drinking, which are more frequent in men.
It is age-related, the 5th and 6th decade of life seems to base of tongue cancer caused by hpv the most encountered, but in the base of tongue cancer caused by hpv years there is a growing tendency in younger adults years old, below Also, strong relations are emerging concerning HPV infection and oral carcinoma, especially the 16th subtype seems to be involved in cancer pathology 2.
What is sure is that HPV in oncologic patients is a negative prognosis factor.
Diagnosis Before developing cancer tumors, patients can present with mucosal lesions such as leukoplakia, erythroplakia or a combination of the two. Sometimes the onset is missed by the doctor or the patient, as it can mimic numerous benign conditions, but as it develops, the signs of malignancy are more pronounced solid mass, infiltrative, ulcerated lesionand it will generally present in one of the two main stages: base of tongue cancer caused by hpv or endophytic.
For radiological assessment of the cancer patients, the most implied methods are CT scanning for bony invasion and MRI for muscles involvement and to accurately determine the cervical metastasis. PET-CT is a more advanced type of tissue scanning, better suited for preoperative staging, although with a higher cost than normal cell papilloma removal, and it gives clinicians more precise information 4.
Since that time, new data have become available, these have been incorporated into the Monograph, and taken into consideration in the present evaluation.
Cervical metastasis, due to a higher intake of glucose, can be easier detected, as many PET diagnosed occult metastases proved to be malignant at the histological HP report, but sometimes negative masses in PET scan were also found to be positive at the HP examination. It is not a total bullet proof investigation, but is a powerful tool when dealing with cancer patients.
The treatment implies a surgical phase and adjuvant oncological therapy. Even late stages can be surgically cured and the remaining defects reconstructed with the aid of free flaps. The prognosis depends on the negative resection margins 6thus having a safe oncological margin of more than 5 mm and lack of margin dysplasia.
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Because there are situated in the proximity of the lingual cortex, in many cases an en bloc mandible resection should be performed even in earlier stages. Usually, a continuity sparing resection is performed; a segmental resection in moderate stages would not grant an extra benefit regarding the oncologic prognosis, but it will inflict a greater impairment for the patient due to muscle attachment loss 7.
In early stages, the cervical metastases are not that frequent, but in advanced tumors the neck must be carefully checked. When the diagnosis is N0 for cervical metastasis, depending on the tumor pattern, an elective neck dissection can be performed SOH dissectionconsidered to have the same benefits as a radical dissection 8.
Treatment of anterior floor of the mouth carcinomas
Most of the cervical metastases are found in the first three lymphatic levels, so a SOH neck dissection will provide a proper outcome. Adjuvant radiotherapy and chemotherapy are performed when positive margins are found, or the tumor has a vascular or neural proliferation. Regarding the cervical metastases, adjuvant therapy is applied when there is a positive carcinoma involvement, irrespective of capsule integrity 9.
Radiotherapy as first therapy is employed in advanced stages where surgical cure cannot be performed, as a palliative treatment or for tumor conversion.
Case 1 Figure 1.
Case 1. Above — anterior FOM tumor.
Below left — CT scan, no bony invasion. Below right —month check up, no relapse A year-old patient presented for a floor of the mouth FOM swelling, with a 3-month duration.
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- Tratamentul carcinoamelor de planşeu oral anterior
- Genden masterfully blends two lauded Thieme books, Reconstruction of the Head and Neck, focusing on defect repair, and Head and Neck Cancer, a multidisciplinary, evidence-based approach to treatment.
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The patient had an ulcerated fixed tumor mass with irregular shape and borders, with pain on palpation, without any clinical signs of cervical metastasis. A biopsy was taken squamous carcinoma and an en bloc resection with marginal mandible resection was performed, with primary closure. At the month follow-up, no sign of relapse was noted locally and cervical. Case 2 Figure 2A.
1. Exposure Data
Case 2. Above left — anterior FOM tumor. Right — cervical metastasis Figure 2B. Above — intraoperative photo: neck dissection. Below — intraoperative photo with the reconstructed defect with lingual flap A year-old patient was sent to our department by an ENT colleague for an anterior FOM mass with cervical lymph node involvement. CT scan showed an anterior FOM tumor without bony invasion, but in close contact with the mandible, and left cervical metastasis.
A biopsy was performed — squamous cell carcinoma. An intraoral en bloc resection was performed with mandible partial resection and neck base of tongue cancer caused by hpv, primary closure with lingual flap.
Adjuvant oncologic treatment was performed. The patient is tumor-free after 18 months. Case 3 Figure 3.
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Case 3. Below left — anterior FOM tumor.
Below centre — the defect. Below right — intraoperative photo with the reconstructed defect with lingual flap A year-old patient was sent to our department by the general practitioner for an anterior FOM mass, recently developed. The CT scan showed an anterior FOM mass, with muscle involvement, without bone invasion, without node metastasis.
A pull-through approach was performed, with en bloc resection, with mandible marginal resection, bilateral SOH neck dissection, primary closure with lingual flap. The patient is tumor-free after 12 months.
Conclusions Early stage anterior FOM carcinoma without lymph node involvement can be safely managed with intraoral surgical resection and primary closure or reconstruction with local flaps. In late disease, the approach is combined oral and cervical, or cervical by pull-through procedure, addressing the tumor and the lymph nodes.
Head and Neck Cancer: Eric M. Genden · | Books Express
Adjuvant oncologic treatment is performed, respective of node involvement and tumor pattern and margins. Conflict of interests: The authors declare no conflict of interests. Criteria to rationalize population screening to control oral cancer. Oral Oncol. Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review. Cancer Epidemiol Biomarkers Prev.
Tratamentul carcinoamelor de planşeu oral anterior
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