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Common head and neck viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Surgery is the mainstay of treatment. A primary en-bloc resection with a minimum of 5 mm final pathological margins is the gold standard surgical aim and a pre-operative decision should be made how best to achieve this result. A number of approaches are possible depending on the site and stage of the primary tumour. Transoral excision comprises the most common approach although significant oropharyngeal extension or trismus is the main contraindications to this technique. A visor flap with lingual release allows a drop-down technique, allowing the primary tumour to be excised in continuity with the neck dissection. While this allows a more controlled floor of mouth and posterior tongue excision, repair of the floor of mouth with appropriate reconstructive techniques must then be considered in order to separate the anatomical spaces that have been joined in the resection. Finally, mandibulotomy, usually combined with lip split, allows access to large tumours. Maintenance of occlusion and cosmetic complications due to the lip and skin incisions both need consideration and numerous modifications of technique have been recommended to minimise morbidity. In very advanced disease or patients with significant comorbidities, palliative approaches may be appropriate.
Oral Cavity Tumours Including Lip Reconstruction
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The floor of mouth is the mucosal lining of the anterior and lateral floor of the mouth. The area is bound anteriorly and laterally by the attached mucoperiosteum of the mandibular alveolus. The lateral floor of mouth is bound posteriorly by the anterior tonsillar pillars. Medially the floor of mouth merges with the ventral and lateral aspects of the tongue. The WHO classifies this anatomical site as ICD-10 C04.1
Oral cavity malignancy
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Small defects of the lateral tongue can be managed by primary closure or be allowed to heal by secondary intention with little or no functional impariment. Larger defects (e.g. T2, T3 and T4 resections) require formal reconstruction to encourage good speech and swallowing. Free tissue transfer of suitable tissue (e.g. a radial forearm flap [Figure48.18], or ALT), utilising microvascular anastomosis in most instances, gives a good functional result. Large-volume defects, including total glossectomy, may require more bulky flaps such as the rectus abdominus free flap or ALT depending on patient body habitus. If feasible, the preservation of one or both hypoglossal nerves is useful to encourage floor of mouth function to help relearn swallowing.
Does the mandibular lingual release approach impact post-operative swallowing in patients with oral cavity and/or oropharyngeal squamous cell carcinomas: a scoping review
Published in Speech, Language and Hearing, 2023
N. M. Hardingham, E. C. Ward, N. A. Clayton, R. A. Gallagher
The MLRA is appropriate for large or inaccessible OC/OPSCC and is referred to in the literature as the ‘mandibular lingual release approach’ (Song et al., 2013; Stanley, 1984; Stringer et al., 1992) and in conjunction with the term ‘visor flap’ (Cilento, Izzard, Weymuller, & Futran, 2007). Where clinically indicated, the technique is preceded by a unilateral or bilateral neck dissection. This is then followed by an incision from the mastoid to mastoid, with an apron flap raised to the level of the mandible. The mandibular periosteum is then incised at the lower border. The alveolar mucosa is also incised around the lingual surface at the teeth from angle to angle, if teeth are absent, the incision is continued along the apex of the alveolus. The anterior belly of digastric is detached from the mentum. The geniohyoid and genioglossus muscles are detached from the genial tubercle. The periosteum is then elevated to the insertion of the mylohyoid muscle. This then allows delivery of the tongue and floor of mouth (FOM) into the neck. Following appropriate resection, closure of site can be done locally or via a free flap.
A prospective 5-year study of trismus prevalence and fluctuation in irradiated head and neck cancer patients
Published in Acta Oto-Laryngologica, 2022
Susan Aghajanzadeh, Therese Karlsson, My Engström, Lisa Tuomi, Caterina Finizia
All patients with a primary diagnosis of HNC in the region of Western Sweden attend a weekly multidisciplinary tumor conference at Sahlgrenska University Hospital in Gothenburg, Sweden. Between the years 2007 − 2012 patients were consecutively asked for study participation if they fulfilled the inclusion criteria. These included being at least 18 years of age, receiving curatively intended radiotherapy with or without chemotherapy/surgery and a tumour site in the oral cavity (tongue, gingiva and floor of mouth), oropharynx (tonsil or base of tongue), nasopharynx (including nasal cavity and paranasal sinuses), salivary glands or cervical carcinoma of unknown primary (CCUP). Exclusion criteria encompassed recurrent disease, a tumor site not expected to be associated with the development of post-radiation trismus (larynx, oesophagus or hypopharynx), surgical treatment alone, a performance status or mental capacity too poor to partake in examinations.
Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study
Published in International Journal of Speech-Language Pathology, 2022
The findings in this study revealed that effortful swallowing increased pressure in the velopharyngeal and mesopharyngeal regions. Differing results have been reported in respect of the physiological changes in pressure in the mesopharyngeal region during effortful swallowing (Hoffman et al., 2012; Takasaki et al., 2011). Hoffman and colleagues (2012) revealed a slight decrease in mesopharyngeal pressure during effortful swallows in healthy adults. Having reported an increase in velopharyngeal pressure and a decrease in mesopharyngeal pressure, Hoffman and colleagues (2012) posited that effortful swallowing is a floor of mouth event rather than a base of tongue event. However, the conclusion posed by Hoffman and colleagues (2012) is not supported by the findings in this study since effortful swallowing resulted in an increase in both velopharyngeal and mesopharyngeal regions in adults with dysphagia.