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Surgery

The decision to perform surgery for oropharyngeal cancer depends on the location of the lesion and the functional deficit that would/could result. For example, surgery would be preferred for tonsillar pillar cancer, but radiation would be preferred for base of tongue tumors where surgery could cause deficits in speech and/or swallowing.

Cordectomy (removal of a single vocal cord) is an option for low stage vocal cord lesions. Partial or hemilaryngectomy can be performed to retain some voice function.

Modified radical neck dissection (cervical lymphadenectomy) is an option as part of definitive therapy, as a diagnostic procedure when the size of the primary indicates a possibility of nodal metastases, or as a secondary procedure if irradiated cervical nodes persist in size or recur.

A radical neck dissection removes all tissue from mandible to clavicle, from anterior border of trapezius muscle to midline strap muscles, in the plane of the deep cervical fascia, including accessory nerve, internal jugular vein, and sternocleidomastoid muscle; severe disfigurement results. A modified radical neck dissection spares the accessory nerve and/or the sternocleidomastoid muscle. A partial neck dissection removes all or part of the lymph node chain(s), or at a minimum, a nodal mass.

Laser surgery is becoming more commonly used for excisional biopsies, debulking, and some types of resections (small tumors and vocal cord lesions). Cryosurgery is another method of removing oral cancers: the tumor is frozen, after which it becomes necrotic and sloughs off.

Considerations for reconstruction should be included in the planning process for surgical resections of head and neck cancers, particularly for oral cavity, lip, sinus, and other visible sites. Preservation of facial nerve function is important when planning treatment for salivary gland cancers.

Lobectomy is performed for thyroid cancer, but about 10% of cases will have a recurrence in the thyroid. Near-total thyroidectomy is preferred treatment, leaving a small amount of thyroid and parathyroid tissue behind.

Key word:

MOHS technique—also called chemosurgery—serial shave excision procedure removing layers of skin tumor to assure that all signs of malignancy have been removed from the base of the tumor

Caldwell-Luc procedure—opening the maxillary sinus by way of an incision into the supradental fossa opposite the premolar teeth
Maxillary exenteration—removal of entire contents of maxillary antrum

Composite resection (also called "commando" procedure—en bloc resection of primary tumor, cervical nodes, and part of mandible if tumor lies close to bone

Types of Surgey