Complications from surgical treatment of oral cancer

Cancer of the oral cavity and oropharynx remains among the top ten most common malignancies in the United States, Europe, and worldwide (Shah et al., Oral cancer, Martin Dunitz an imprint of Taylor and Francis Group, London, 2003). Over the last 30 years the philosophies of treatment of oral cancer have changed very little with regards to primary tumor extirpation, with the exception of marginal mandibular resection. There have been major changes in the approach to cervical lymph nodes at risk for metastasis (Kim and Ord, Oral Maxillofac Surg Clin North Am 15:213-227, 2003). The radical neck dissection, once advocated by Dr. Crile as the only appropriate treatment for the neck, is now rarely performed in most centers (Shah, Cancer of the head and neck - atlas of clinical oncology. In: Management of cervical metastasis. BC Decker Inc, London, 2001). In addition, organ preservation protocols involving chemo-radiation therapy, although not without adverse effects, have significantly altered the quality of life for the cancer patient. Also, the ability to offer a variety of reconstruction options with the available hardware, local and regional flaps, as well as free tissue transfer from distant sites, has contributed to the overall significant improvements in functional and esthetic outcomes. The head and neck cancer patient in the new millennium has the opportunity to emerge from an extensive ablative surgical procedure with excellent functional and esthetic results. Despite these surgical advances, the ablative process still results in the sacrifice of several functional and esthetic organs during surgery for cancer of the oral cavity (Shah, Cancer of the head and neck - atlas of clinical oncology. In: Management of cervical metastasis. BC Decker Inc, London, 2001). Early complications from ablative surgery for oral cancer are, for the most part, similar to those from other sites. Long term complications however are quite challenging for the oncologic team as well as the patient who survives oral cancer, primarily due to the highly specialized regional tissues involved in the surgical field.