Management of clinically malignant lumps

The characteristic features of fixation to adjacent structures, facial nerve malfunction, and enlarged lymph glands are usually indications of malignancy. In this situation the diagnosis may be safely established by incisional biopsy. If malignancy is confirmed, the subsequent wide surgery will remove the biopsy wound and there will be no risk of tumour seeding.

Following microscopic confirmation, a CT or MRI scan will help to determine the local extent of the tumour. Treatment must be planned in conjunction with radiotherapy, faciomaxillary, and plastic surgery colleagues. Adjuvant radiotherapy is most commonly delivered post-operatively, but also as a split course, giving two-thirds of the treatment before and one-third after the operation.

Pre-operative radiotherapy has two advantages: a large tumour mass may shrink considerably, simplifying removal; and sometime an inoperable tumour will be rendered operable. However, surgery after radiotherapy is technically demanding.

0 0

Post a comment