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Head and Neck Cancer - OMFS - Coggle Diagram
Head and Neck Cancer - OMFS
Risk Factors
Smoking
EBV
Only oropharyngeal cancers
Way better prognosis
Primary radiotherapy won't have surgery won't be i
Alcohol
Betel Quid
HPV
Hereditary conditions
Immunosuppression
chronic Infection
Potentially / pre-malignant
Mouth Vs Oropharynx
Pharynx
Nasopharynx
Oropharynx
Premalignancy / Potentially Malignant
Dysplasia
Biopsy
Signs / Symptoms of A Cancer
Signs
Non healing ulcer
Persistent
LEsion pigmentation with progressive increase in size
Mets
Symptoms
Sensory nerve deficit
Pain
Chronic otalgia
Dysphagia
Staging AJCC / UICC 8th Edition
Why
Prognosis
Treatments
Communication with collegue
Head and neck cancer all about Nodal Mets
Nodal Metastasis - prognosis is halved!
Staging Investigations
T
MRI: soft tissue
CT: bone invasion
N
M
Operable Management
Can Get around the tumour with a 5-10mm margin
How much do we take
Management of neck: regardless of how small the tumour - stage the neck
Reconstruction
Protection of the airway : +/- tracheostomy
Access
Transoral
Lid split madibulotomy
Weber Fergusson Access incision
Management of the Neck
De Cruz Paper 2015 New England Journal
Even in early oral cavity cancers the risk for mets is too high not to do neck dissection
Pts with elective neck dissection had a better prognosis over watch and wait group
Neck dissection
Taking out lymph nodes of the levels of the neck that you think are draining the neck
Invariably done
Margins
MDT decides
Variable
Goal Clear margins
Recontruction
Why
Restore function and form
Asthetics
Preserve / restore speech, chweing, swaloo
How
Ideally replace like with like
Challenges
Anatomical and physiological / functional complexity
Varitety of tissues
Saliva is microbially rich
Radiotherapy: necrosis, fibrosis, avascular tissue
Principles
Free Tissue Transfer
Most tissue types including skin, fascia, muscle, tendon, and bone can be harvests
Focus on removal with clear mrgins and can maintain function
Radiotherapy has to happen within 6 weeks of cancer surgery but need wound to be healed
Types
Radial Flap
Allen's test
Fibular free flap
C
Needs to have collateral blood supply bc you are ting artery
Virtual Surgical Planning
Bony Reconstuction
CT scan of tumour
CT scan of bone
Match defect to bone
Cutting guides
Bone to bone contact
Zygomatic Implant
Attached teeth to it - anchor
Zygomatic Implant Perforated Flap ZIP Flap
Seperates nasal and oral cavity with zygomatic implant to attach dentures to
Radiotherapy
Adjuvant
Indications
Nodal mets
Tumours with adverse features
Extranodal extension
Multiple small mets
Major criteria
Extranodal extension and / or involved margin (<1mm)
Minor criteria
Close margin
Mutliple nodes
Largest node >3cm
LVI
Immunotherapy
Immune checkpoint inhibitors
Haven't changed survival in Head and Neck Cancer