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BDS4 Head and Neck Cancer symposium > Surgical Aspects of H/N Oncology > Flashcards

Surgical Aspects of H/N Oncology Flashcards

1
Q

Epidemiological facts/figures for Oral cancer:

A

90% oral/OP cancer is squamous cell carcinoma

6% of cancers overall

5 year survival for oral cancer is 46%

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2
Q

What are the risk factors for oral cancer?

A
  • Alcohol and cigarettes (synergistic as alcohol acts as a solvent)
  • Betel use
  • Poor OH
  • HIV
  • EBV
  • HPV
  • Diet
  • Genetics
  • Previous SCC
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3
Q

What sites on the oro-pharnyx are commonly affected by cancer?

A

Contains lymphoid tissue (affected by HPV driven disease)
- Base of tongue
- Tonsil
- Soft palate (lateral aspect)

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4
Q

What are the common sites for oral cancer?

A
  • Buccal mucosa
  • Retromolar trigone
  • Alveolus
  • Hard palate
  • Ant 2/3 tongue
  • FoM
  • Lip mucosa (wet vermillion backwards)
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5
Q

What stain can be used to detect dysplasia?

A

Lugol’s iodine
-> non-staining areas- dysplastic field change

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6
Q

What other cancers are common in oral cavity?

A

SCC

Lymphoma

ACC

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7
Q

What is the management/treatment plan for patient with head and neck cancer based on?

A
  • Best options for patient
  • Degree of fitness of patient
  • Co-morbidities
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8
Q

What is the difference between curative and palliative?

A

Curative- degree of cure over 5 year period

Pallaitive- unlikely to be cured but aim to control disease for sustained period
 Chemo, radio, immunological, surgical
 May choose to manage symptoms with analgesia and other adjuncts

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9
Q

What are the treatment options for oral cancer?

A

Surgery alone- low volume disease

Radiotherapy- OPC

Chemotherapy

Dual/triple modality treatment (may include immunotherapy)

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10
Q

What are the surgical options for treatment of oral cancer?

A

Resection and pack- remove tumour and pack (WHV, bismuth and iodiform paste, ribbon gauze)

Resection and primary closure
-> Wedge resection of tongue tumour

Resection and reconstruction

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11
Q

What are the flap options for reconstruction in oral cancer patients?

A

Local flap- rotation flap within mouth
-> Palatal

Pedicled flap- FAM
-> Facial artery myomucosal flap

Free flap- tissue from elsewhere and reimplant into blood supply of new area
-> Should withstand radiotherapy

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12
Q

What are the options for managing the neck?

A
  • No staging
  • Imaging- ultrasound and CT for lymphadenopathy
  • Staging- sentinel node procedure (t99 with gamma camera to look for certain nodes)
  • Selective neck dissection- levels 1-3/1-4
  • Comprehensive neck dissection- obvious nodal disease clinically and on scanning
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13
Q

What can CT be used for when planning resection?

A

Can outline tumour in red- volumetric analysis
-> 1cm around this area we put green line to give idea of structures that may need to be removed in resection
-> If unable to get a margin- consider not doing a resection
-> Idea of surgery is to achieve clear margin

Can look at arteries, nerves etc to avoid

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14
Q

What are the benefits of 3D planning for reconstruction on CT?

A
  • Model/mirror imaging to model affected side the same as other side if sizable defect likely after surgery
  • Cutting guides and templates to help with resection and reconstruction if bony
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15
Q

Why is reconstruction of mandible necessary?

A
  • Airway would be comprimsied if not
  • Poorer swallowing- issues with hyoid
  • Tracheostomy device dependent
  • Aesthetic issues
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16
Q

How is blood supply plumbed in a free flap?

A

Anastomose flap to vessels in the neck (end to side or end to end)

17
Q

What type of flaps can be used for tongue?

A
  • Fasciocutaneous (arm)
  • Musculocutaneous
18
Q

What can tongue flapped be shaped to control?

A

Movement

Tethering

19
Q

Why is an adequate amount of bulk required for tongue flap?

A

For palatal contact required to initiate swallowing in total/subtotal glossectomy

20
Q

What flap is used for a total glossectomy?

A

Cathedral triptych- comes from leg
 Produces neotongue
 Skin on surface with flap underneath

21
Q

What kind of flap is used for FoM?

A

Radial Forearm flap

22
Q

What are the aims for flaps in FoM?

A
  • Try to preserve keratinised mucosa overlying the alveolar ridge where possible (allows implants)
  • Avoid entraining non-attached/NK mucosa
  • Try to maintain sulcus depth where possible
23
Q

What can be done for hair growing on the flap?

A

Lasered off

Will stop with radiotherapy

24
Q

What flap is used for the buccal space?

A

Radial forearm

25
Q

What are the aims/considerations for buccal space flaps?

A
  • Maintain sulcus depth
  • Beware of involvement of commissure- need to weigh up oral stoma/aperture size vs oral competence (issue if not small enough)
26
Q

What are the options for flap in buccal region if it is through and through (external cheek skin is removed)?

A

2 fasciocutaneous flaps

Chimeric flap
-> difficult to avoid tight vertical blind which creates issues with space/retention of protheses

Cervicofacial- better aesthetics and skin match (not good for function)

27
Q

What can be done to flap at the commissure if it is not correct thickness?

A

Reduce it down over time

28
Q

What flaps are used for mandible?

A

Soft tissue quality is important:
- DCIA (hip) with int oblique- keratinises well but difficult sulcus zone
- Scapula with various skin paddles (NK)
- Fibula with skin (difficult to adapt to sulcus)

29
Q

How long does bone stock from flap last after radiotherapy?

A

3-5 years

30
Q

When is the optimum time to place implants in flap for mandible?

A

While the source is still in situ as normal
-> on leg etc

31
Q

What flaps are used for maxilla?

A
  • Low level maxilla require soft tissue only reconstruction
  • Use of Zip flaps- zygomatic implants
  • Composite flap (if bigger disease) depends on contour/bone stock
  • Soft tissue DCIA with internal oblique is best
  • Scapula (difficult to retain implants) with various options next then fibula with skin
32
Q

What must be done for flap in maxilla to create space for prostheses?

A

It must be hitched up

BDS4 Head and Neck Cancer symposium (5 decks)

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