The extirpative surgeon has a number of options in exposing oral malignancy, and selects among these based on tumor size and location, and whether lymphadenectomy is prudent. Once an oncologically sound procedure is planned, the reconstruction should be designed to provide for optimal reconstruction based on the expected defect and functional deficits. Options include transoral exposure, midfacial or lower facial degloving, and lip splitting with mandibular rotation, the latter to which a lingual release or transhyoid adjunct can be useful in selected cases. Whatever the approach chosen, preservation of the form and function of uninvolved structures adjacent to the tumor is desirable, controlling the resection margins between such structures and the tumor with intra-operative frozen section studies. For other than small malignancies that can be encompassed by transoral excision, the head and neck reconstructive surgeon is consulted pre-operatively, meeting with the patient and then reviewing with the extirpative surgeon the alternatives in reconstruction, and later rehabilitation, of each patient based on the anticipated resection and any adjunctive therapies such as irradiation.
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