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DR. M. VIJAYAKUMAR
M.B.B.S, DIP N.B.(GEN SURG)M.Ch (ONCO)
WHAT
WHEN WHY HOW
TO DO ?
EHABILITATE
ROLES
IMAGING vs SURGICAL
TECH
1.CLINICAL 2.C.T. SCAN 3.MRI 4.U/S GD FNAC
ACCURACY (%)
59 66 75 86
IN METASTATIC DISEASE
LEUKOPLAKIA ERYTHROPLAKIA
AIM
TO GET DISEASE FREE MARGIN
ANAESTH
TRACHEOSTOMY
ENDOSCP ASSTD. INTBN
SURGERY
< 1 cm W.E
THICK SUBOPTIMAL
COSMESIS
RND / CLASSICAL ND
COMPREHENSIVE
SUPRAHYOID SUPRAOMOHYOID
IN CONTINUITY
T + N + MAND.
MANDIBLE SPARED
DIS. REMVD IN TWO PIECES
RATIONALE
RND/MND THERAPEUTIC > I LEVEL INVLD RISK FOR > I LN INVLD REC. > 2-3 cm SIZE
MOLECULAR
TREAT. AIM
INSTITUTIONAL INDIVIDUAL
BIAS
NO CONSENSUS
USEFUL GUIDELINES
PRIMARY
T1 T2 T3 T4 SURG. OR R.T <3CM TREAT AS T1 >3CM - SURG + RT SURGERY +RT OR CON. RT + CT
SURGERY+RT OR ANT. CT SURG.+RT OR CON.RT+CT SURG.
NECK - LN
NO N1 N2 N3
LOW RISK WAIT & WATCH CND +/- RT MOBILE CND + RT a) MOBILE SAME AS N 2 b) FIXED OPTIONS : *PALL. RT OR *ANT. CT MOBILE & TREAT AS IN (a) *OR CON. RT+CT PROCEED
TREAT. S / RT/ CT
THANK YOU