This page was reviewed under our medical and editorial policy by
Beomjune B. Kim, DMD, MD, FACS, Head and Neck and Microvascular Reconstructive Surgeon
This page was reviewed on November 17, 2021.
Depending on the stage of oral cancer, the patient's doctor may recommend oral cancer surgery as a treatment option.
The type of surgery depends on a variety of factors, including the location of the cancer, the cancer stage and any quality-of-life issues the patient may be concerned about. Surgical options available for oral cancer patients include those below.
An operation to remove a tumor is called a tumor resection. In this procedure, some normal tissue surrounding the tumor, known as a margin, is also removed in an attempt to eradicate as many cancer cells as possible. A small tumor that is easily reached may often be removed through the mouth. For tumors that are larger or harder to reach, an incision may be required in the neck, face, or jawbone.
When a tumor has grown into the mandible (jawbone), a mandibular resection, or mandibulectomy, may be needed, depending on the location of the mouth cancer. In this procedure, all or part of the jawbone is removed. If the jawbone appears normal in an X-ray and no other evidence of cancer cells is found in the area, just a small piece of the bone may be removed. However, if the X-ray shows cancer in the jawbone, then the entire bone may need to be removed.
The type of glossectomy performed to remove cancers of the tongue may depend in part on the size of the tumor. When a tumor is very small, tongue cancer surgery may be limited to a partial glossectomy. Larger tumors may require a full or total glossectomy—removal of the entire tongue.
This operation removes all or part (partial maxillectomy) of the hard palate, the front of the roof of the mouth. A special denture may be created to fill the hole left by this surgery. The care team will likely refer patients who require jaw cancer surgery to a prosthodontist, a specialized dentist, to make a prosthetic tailored to his or her mouth. If a large portion of or the entire jawbone must be removed, then prosthesis may not be possible. Then, a surgical reconstruction of the maxilla may be recommended.
During a laryngectomy, a surgical oncologist removes the voice box along with the primary tumor. When a large tumor has grown on the tongue or in the oropharynx, it may be necessary to remove some tissue involved in swallowing to remove as many cancer cells as possible. As a result of this process, food may enter the windpipe (trachea) and then the lungs, which may cause pneumonia. When the risk of pneumonia is high, a laryngectomy may be recommended. With this procedure, the windpipe is attached to a hole in the skin of the neck for breathing. A laryngectomy does not always leave the patient unable to talk. Several techniques are available in some circumstances to restore vocal capabilities after a laryngectomy.
This type of oral cancer surgery is used to remove lymph nodes in the neck if cancer has spread or is suspected to have spread to this area. Depending on the size and extent of cancer in the lymph nodes, different neck dissection procedures are recommended, among them:
Other surgical oncology procedures for oral cancer include:
When a large tumor is removed, the mouth, throat or neck may require repair of some kind. Sometimes, a skin graft may be performed. In this instance, a thin slice of skin is removed from the thigh and reattached in the oral cavity area in need of repair. When the defect is larger, a piece of muscle, with or without skin, may be shifted from a nearby area, such as the chest or upper part of the back.
Advances in microvascular surgery, which involves attaching blood vessels under a microscope, have led to improvements in reconstructing the oral cavity and oropharynx. These techniques mean that tissue from distant parts of the body, such as the intestine, arm muscle, abdominal muscle, or even lower leg bone, may be used to replace parts of the mouth, throat or jawbone.
If a tumor in the oropharynx is too large to remove completely, a hole may be opened in the windpipe and front of the neck to allow for comfortable breathing. Sometimes, removing a tumor may lead to extensive swelling in the neck. In this case, the patient's surgical oncology team may perform a temporary tracheostomy, in which an incision is made in the trachea, to ease breathing until the swelling goes down.
A gastrostomy tube is a feeding tube sometimes inserted directly into the stomach. This approach may be recommended if a cancer in the oral cavity or oropharynx is preventing swallowing. A gastrostomy tube may help the patient receive adequate nutrition.
A feeding tube may also be placed in the stomach through the mouth. In this process, known as a percutaneous endoscopic gastrostomy, or PEG, a camera is attached to the end of a long, thin tube, allowing the doctor to see directly into the stomach. Special liquid nutrients may be provided through the tube. These tubes may be inserted on a short-term or long-term basis. They can help keep the patient healthy and fed during treatment, and may be left in after treatment if necessary. The tube may be easily removed as soon as normal eating is possible.
When radiation is used as part of a patient's oral cancer treatment plan, it may be necessary to remove teeth, because exposure of unhealthy teeth to radiation may lead to serious problems. A complete dental evaluation is always performed for patients receiving radiation therapy for oral cancer.
If the patient's surgical oncology team removes his or her jawbone and reconstructs it using bone from another part of the body, dental implants may be placed in the new bone. These implants are hardware that prosthetic teeth can attach to, either during reconstructive surgery or later.
Oral cancer and its treatments, especially surgery, may interfere with the patient's ability to speak, breathe or swallow. These and other side effects from surgery for oral cancer may cause challenges that require supportive care services to help patients maintain or improve their quality of life.
Oral cancer experts work closely with supportive care providers to determine which services patients may need to help them recover from surgery. Supportive care services for oral cancer may include:
The type of supportive care patients need may depend on a variety of factors, including the type and location of cancer, the extent of the surgery and their overall health.
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