Head and Neck Surgery and Oncology
Core rules
Oral cavity squamous cell carcinoma is staged by AJCC 8th edition, with depth of invasion determining T category. Early glottic cancer (T1a) can be treated with radiotherapy or transoral laser microsurgery; supraglottic cancer often presents with nodal metastasis. Neck levels I–V guide dissection; early oral cavity cancer with N0 neck usually undergoes selective dissection of levels I–III. Thyroid nodules are evaluated by ultrasound and Bethesda FNA. Papillary carcinoma spreads lymphatically, follicular carcinoma hematogenously, medullary carcinoma arises from C cells with calcitonin as marker, and anaplastic carcinoma is aggressive. Parotid pleomorphic adenoma is the commonest benign salivary tumor; Warthin tumor is second. Facial nerve preservation is central in parotid surgery. An adult neck mass is malignant until proven otherwise and needs FNA and imaging, not blind excision. Reconstruction follows a ladder: primary closure, skin graft, local flap, regional flap such as pectoralis major, and free flap such as radial forearm or fibula.
Worked example
A 58-year-old smoker has a 2-cm level II neck mass. FNA shows squamous carcinoma. Panendoscopy identifies a tonsillar primary; PET-CT stages the disease. Treatment is surgery or chemoradiation according to stage and multidisciplinary review. Blind excision would violate oncologic principles.
Traps
Do not excise an adult neck mass before FNA and imaging. Do not assume a thyroid nodule is benign without ultrasound risk stratification. Do not sacrifice the facial nerve without histologic evidence of invasion. Margin status and extranodal extension change adjuvant therapy.