Head and Neck Oncology and Ablative Surgery
Core concepts
Know staging and workup for mucosal head and neck SCC: TNM, nodal levels, and the role of imaging and panendoscopy. Understand neck dissection classifications (radical, modified, selective) and levels I–VI, plus sentinel node concepts for oral cavity. Know indications for adjuvant therapy (positive margins, extracapsular spread, multiple nodes, perineural/vascular invasion) and the role of concurrent chemoradiation. Understand ablative principles: en bloc resection, margins, and management of the mandible (marginal vs segmental). Recognize salivary gland tumors (pleomorphic adenoma vs malignancy; facial nerve management in parotid cancer) and thyroid cancer surgical principles including recurrent laryngeal nerve and parathyroid preservation.
Traps
Questions test when to sacrifice the facial nerve (malignancy with invasion) versus preserve it. Another trap is confusing elective neck dissection indications in oral cavity cancer (depth of invasion threshold). Know that extracapsular spread is a major adjuvant indication. Also know the difference between positive and close margins and how they affect re-resection versus radiation.
Worked example / rule of thumb
Oral tongue SCC with depth of invasion >4 mm and clinically N0 neck: perform elective neck dissection (levels I–III). Rule of thumb: deep invasion → treat the neck; positive margin or ECS → adjuvant therapy.