Oral and Maxillofacial Oncology and Reconstructive Surgery
This domain tests staging, margins, neck management and reconstruction choice.
Core rules
- Oral squamous cell carcinoma risk factors include tobacco, areca nut, alcohol and HPV, especially in the oropharynx. Examine mucosa, tongue mobility, floor of mouth and cervical nodes.
- Biopsy confirms malignancy. CT, MRI and PET-CT stage advanced disease. TNM staging guides treatment, ideally in a multidisciplinary tumor board.
- Aim for clear margins and use frozen section when available. Neck dissection is used for clinically node-positive disease and for high-risk occult disease.
- Reconstruction options include local flaps, radial forearm free flap for soft tissue, fibula free flap for mandible, scapula and anterolateral thigh flaps. Consider bone, soft tissue and future dental rehabilitation.
- Complications include fistula, flap failure, osteoradionecrosis and medication-related osteonecrosis. Dental extractions before radiotherapy require planning.
Worked example
A 60-year-old has a nonhealing floor-of-mouth ulcer and a firm submandibular node. Biopsy confirms SCC. Stage with CT or MRI and plan neck dissection plus resection with free flap reconstruction. Do not perform a small excision without staging the neck.
Traps
Biopsying without assessing nodes; ignoring persistent leukoplakia; not planning dental clearance before radiotherapy; attributing trismus only to TMD.