Introduction

Squamous cell carcinomas account for about 90% of all malignant neoplasms in the mouth and orophar-

ynx. It is important to consider the site of involvement as the epidemiological factors can vary considerably in tumours in different intraoral locations. There is typically a higher frequency in men than women, and this is attributed to the use of tobacco and alcohol [17]. It has been estimated that as many as 75% of cases of oral squamous cell carcinomas in Western countries and Japan can be ascribed to these factors. Globally, oral cancer accounts for 5% of all malignancies in men and 2% in women [134]. Much higher rates, however, are seen in both men and women in parts of southeast Asia, where they are usually associated with the habitual use of areca nut and tobacco products.

Despite the fact that oral tumours frequently cause symptoms, and the mouth can be readily visualised with simple equipment, many oral cancers present at a relatively advanced stage where treatment may be disfiguring and prognosis is poor. This is often because many patients are elderly and frail and frequently wear dental prostheses and are accustomed to minor degrees of oral discomfort. In addition, early lesions may not be regarded as suspicious by the patient or the clinician and may therefore be treated empirically with antibacterial or antifungal preparations.

Any part of the oral mucosa can be the site of development of squamous cell carcinomas. The common oral locations can show wide variations in different geographical areas depending on the prevalent risk factors. The intraoral subsites include the buccal mucosa, tongue, floor of mouth, upper and lower gingivae and alveolar processes, the hard palate and retromolar tri-gone. As the clinical presentation can vary according to the specific sites of involvement, these will be discussed separately.

The buccal mucosa extends from the commissure anteriorly to the retromolar trigone posteriorly and from the upper and lower vestibular reflections. The majority of carcinomas arise from the posterior area where they are commonly traumatised by the molar teeth. They soon spread into the underlying buccinator muscle and though insidious initially they may eventually cause trismus. Bone, however, is generally involved only in advanced tumours. Tumours at this site often extend posteriorly into the palatoglossal fold and ton-sillar fossa. Metastases are most common in the sub-mandibular, submental, parotid and lateral pharyngeal lymph nodes.

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