Oral cavity cancer is an uncommon malignancy with a significant impact on both patients and health care resources. The current standard of treatment includes surgery and adjuvant external beam radiotherapy. Advances have been made with improved methods of reconstruction and rehabilitation that have significantly impacted on disease-specific outcome and quality of life.
A multidisciplinary approach in the treatment of oral cavity cancer is vital to achieve the best results. It provides close interaction between the head and neck oncologist and other members of the team. This is especially important for both ablation and reconstruction, as a careful balance needs to be established between tumor resection and quality reconstruction.
Tumors of the upper aerodigestive tract can be difficult to treat given the complex nature of the oral cavity. Great advances have occurred in both patient selection and tumor evaluation where radiology has become standard of care and includes computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scanning. In addition, better medical management, improved anaesthetic techniques and close post-operative monitoring have allowed patients to undergo complex procedures with limited morbidity.
The goals of successful reconstruction are to recreate normal oral function, provide a satisfactory cosmetic result and permit prompt and careful follow up. This can be challenging as oral cavity tumors can extent to involve a number of critical sites (i.e., mandible, paranasal sinuses, orbit and skull base) and cause significant functional disabilities in terms of airway, speech, swallowing, and/or mastication.
A better understanding of normal oral function has resulted in the reconstruction of "like with like.'' Advances in surgical technique, improved knowledge in vascular anatomy and the development of more compatible biomaterials have allowed surgeons to perform the most complex of reconstructive techniques. A menu of reconstructive options includes free grafts, local tissue rearrangement, pedicled flaps, and vascularized free tissue transfer. This permits the successful transfer of skin, muscle, and/or bone to an otherwise hostile environment.
Successful rehabilitation would not be complete without the support of a variety of ancillary medical services including speech pathology, dietitians, and nursing staff. In addition, advances in the development of oral prostheses and dental implants have resulted in state-of-the-art and timely rehabilitation in patients with oral malignancies.
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