Patients with oral cancer and other types of chronic diseases involving the jaw may require reconstructive jaw surgery to restore the shape, appearance, or function of the jaw after treatment. This procedure is planned in conjunction with other caregivers to time the surgery appropriately. The goal is to treat mandible malformations as soon as possible, without compromising patient care; for example, a cancer patient needs to be fully treated before reconstructive surgery can be performed.
Oral Cancer Surgery
The mouth is composed of several anatomical subdivisions, with different functions and characteristics.
Some of the structures that make up the mouth are the lips, gums, hard palate, retromolar area, floor of the mouth, oral mucosa and oral tongue.
Each of these regions has particularities, including with regard to the formation and evolution of diseases such as cancer.
Thus, mouth cancer surgery is performed according to the location of the tumor, and there are different techniques adopted according to the patient’s needs and the characteristics of the case.
First, it is necessary to evaluate the location of the tumor (what is called mouth, in fact oral cavity, is divided into several regions, namely: lip, floor, tongue, alveolar edge, palate and jugal mucosa), and for each part of these there are surgical procedures with their particularities.
Besides, you need to know the extent of the tumor, so we know how much it will be removed.
In addition, it is often necessary to make an extension of the surgery to the neck, in order to remove cervical lymph nodes affected by the tumor (the so-called cervical emptying surgery, which can be of various types and extensions depending on each case).
For many cases it is necessary a protective tracheostomy and some kind of reconstruction (with removal of other parts of the body to cover the surgical defect, the so-called flaps). All this means that, especially for the more advanced cases, these surgeries can be very complex, time-consuming, and require multidisciplinary staff (such as plastic reconstructive surgery).
Surgical techniques for the treatment of oral cancer
To define which surgical technique will be adopted to treat oral cancer, a thorough investigation of each case is carried out. The purpose is to know the characteristics of the tumor, the location and extent of the disease.
In any case, the initial treatment is done by removing the tumor, and it is important to remove a lot of healthy tissue around it, a safety margin. Surgery is usually performed in a hospital environment with the patient under general anesthesia, but minor procedures may occur under local anesthesia and/or sedation.
In case of more advanced tumors, depending on the surgical extension, it may be necessary to perform a tracheostomy, to serve as an alternative to allow breathing after surgery. In addition,lguns patients use nasogastric tube to bring food directly to the stomach until the tissues of the mouth are fully recovered.
Remembering that these approaches are performed according to the case, because the treatment is personalized for each patient. The following are the techniques that are adopted for different locations of oral cancer.
Glossectomy
This surgery is intended for patients who have developed mouth cancer on the tongue. In it, the tumor and a part of the tissue of this organ are removed, so that the disease is fully treated.
When the tumor has smaller dimensions, it is possible to have partial glossectomy, in which only part of the tongue is removed along with the tumor. However, in the most severe cases and tumors that already occupy an extensive part of the tongue, it is necessary to have full glossectomy, removing the entire tongue.
Mandibulectomy
This surgical technique for mouth cancer is also called mandibular resection. As the name suggests, the procedure is adopted for cases where the cancer affected the jaw, the bone that forms the lower contour of the face, containing the chin.
The extent of this surgery depends on the invasivity of the tumor. When the tests do not indicate an infiltration inside the bone it is possible to remove only part of it, along with the tumor (marginal mandibulectomy). But there are cases where it is necessary to remove an entire “slice” of the jaw. In such cases, reconstruction may be indicated using a bone graft, plates and screws, or even skin, muscle, bone and/or other components to replace the mandible.
Maxilectomy
As we explain, mouth cancer can also develop in the hard palate, i.e. the bone part of the mouth sky. In such cases, total or partial maxilectomy is performed to remove the tumor and a section of the tissue from the sky of the mouth.
There are also techniques for rebuilding the palate to maintain the functions of the oral cavity.
Multidisciplinary service
As you saw, surgery for mouth cancer can often bring functional and aesthetic sequelae to the patient, which depends on the type of tumor and the extent of surgery required to remove it. Therefore, it may be necessary for the patient to receive care from a multidisciplinary team.
It involves, for example, the plastic surgeon, clinical oncologist, radio-oncologist, nutritionist, speech therapist, physiotherapist, nurse and other professionals. All work for functional recovery and oncological outcome for the patient.
In any case, the treatment aims to control the disease, maintain the functions of speech, chewing, swallowing and breathing, in addition to the aesthetics of the patient.
