Shih-Jung CHENG
Oral cancer is one of the major cancers in Taiwan especially
for male, and it is the fourth leading cause for male cancer death in Taiwan. Generally, radical resection combined with chemo-radiation
remains the main treatment strategy for advanced oral cancer, although the
5-year survival is not substantially improved and still less than 20%. However,
the advanced oral cancer involving the floor-of mouth, base-of-tongue, nasal
cavity and infratemporal region challenges surgeon’s techniques, but possibly
provides us to ameliorate skills, and in turn to apply to manage difficult head
and neck tumor. Herein, three surgical techniques were introduced, including
pull-through technique, infra-temporal resection and mid-facial de-gloving surgery.
First, pull-through
technique usually applies for resection of tongue or base-of-tongue cancer
involving the floor-of-mouth without mandibular lip splitting. In contrast, the
pull-through mandibular tumor was totally excised from the cervical approach
not in oral cavity. Pull-through technique may decrease complication rate,
spare blood loss, save surgical time, shorten hospital stay duration, and
improve the postoperative esthetics, but the technique should be carefully
applied to ensure the total eradication of the tumor.
Second, the
comprehensive surgery of extensive oral cancers with infratemporal invasion
challenges the surgeon’s judgment and technique. Infratemporal resection is
staged surgical procedures as temporary ligation of ECA, and identification
of ICA, pterygoid plate, choana, E-tube
and styloid process with zygomatic arch approach and downward-outward traction
to sacrifice tumor. The technique may improve some inoperable tumor resected.
However, perio- and post-operative massive bleeding, ECA/ICA injury with
pseudo-aneurysm, hearing loss, blindness or ectropion may be carefully
monitored. However, detailed physical examination and imaging study are of
utmost importance.
Third, mid-facial de-gloving surgery may apply for oral tumor invading into nasal septum or turbinate. The surgical procedure incises the demarcation from nasal approach, followed by intra-oral excision and removed the oro-nasal tumor via oral cavity. The technique is characteristic of preserving upper labial integrity without Weber- Fergusson incision, and furthermore improving post-operative cosmetics.
