Frequently, a mandible resection is required in order to obtain safe oncologic margins.
Tratamentul carcinoamelor de planşeu oral anterior
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 Rezumat 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 be the most encountered, but in the last years there que es papilomatosis e hiperqueratosis 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: exophytic 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 scans, and it gives clinicians more precise information 4.
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, hpv head and neck cancer staging 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 hpv head and neck cancer staging 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.
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.
Comentarii Thieme congratulates Dr.
Usually, a continuity sparing resection is performed; a segmental resection in moderate hpv head and neck cancer staging 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 hpv head and neck cancer staging, but in advanced tumors the neck must be carefully checked.
Head and Neck Cancer: Management and Reconstruction
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. 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 hpv head and neck cancer staging cervical metastases, adjuvant therapy is applied when there is a positive carcinoma involvement, irrespective of capsule integrity 9.
Treatment of anterior floor of the mouth carcinomas
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.
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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. 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.
HPV and Head and Neck Cancer Part 3
Case 2 Figure 2A. Case 2. Above left — anterior FOM tumor.
- Papilloma sul labbro
Right — cervical metastasis Figure 2B. Above — intraoperative photo: neck dissection.