LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery

Section IV: THROAT, TONGUE, AND NECK SURGERY

1-37

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1-37. SURGERY OF THE ORAL CAVITY

a. General. This procedure consists of the excision of benign or malignant lesions of the tongue, floor of the mouth, alveolar ridge, buccal mucosa, or tonsillar area. Benign or small malignant tumors of the oral cavity may be excised without neck dissection. In the presence of tongue cancer without evidence of metastasis, a "prophylactic" neck dissection may be performed in an effort to control a cancerous growth in the upper jugular chain of the neck. When treating a typical carcinoma of the floor of the mouth with involvement of the mandible, a portion of the tongue and the mandible are removed. When there is a lesion of the tonsil or an extensive lesion at the base of the tongue with pharyngeal wall involvement, a resection of the ascending ramus of the mandible is necessary, and portions of the base of the tongue, pharyngeal wall, and the soft palate are removed to secure an adequate margin of normal tissue about the lesion.

b. Patient Preparation. The patient is placed in dorsal recumbent position with shoulders elevated. Generally, endotracheal anesthesia is used, and a pharyngeal pack of moist gauze is inserted in the mouth.

c. Operative Procedure. Although the case may be scheduled as a local excision, frequently lesions of the oral cavity require more extensive excision than planned preoperatively. The setup should be designed to include the instruments for a neck dissection, or to have them available. In most tumors of the oral cavity, a tracheostomy is performed to assure an airway postoperatively.

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