The surgical management of lesions of the oral cavity is complex and requires the surgeon to consider multiple factors. Frequently a multidisciplinary team should be included in the decision-making process, particularly when a malignant lesion is being treated. Preoperative evaluation is critical in determining the optimal therapy and often will include radiologic evaluation and flexible endoscopy in addition to physical examination. Surgical decision making includes determining when a transoral approach is possible and appropriate versus a more extensive surgical approach such as a lip split and mandibulotomy. For small lesions, with a cooperative patient, local anesthesia might be adequate, but often, general anesthesia will be required. For malignant lesions, management of possible cervical node metastasis must be included in the treatment plan. Management of the airway during surgery and postoperatively must also be carefully considered. When there is concern for significant postoperative swelling or trismus, which might make reintubation difficult, tracheostomy should be considered. Primary closure can be effective for small defects. In some circumstances, a skin graft or local flaps can be successfully employed. When surgical excision results in larger defects, reconstruction must be included in the surgical plan.
This review contains 13 figures, 7 tables and 32 references
Key Words: glossectomy, lip split, oral cancer, mandibulectomy, mandibulotomy, maxillectomy, ranula, sialendoscopy
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