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How do you approach a pathologic lesion?
- blood: PTH, Alkaline phosphatase, rarely diagnostic
- Imaging: angiography, contrast, MRI(soft tissue), scans
- Aspiration: simple, distinguish benign from malignant
- Biopsy: most definitive
What is segmental resection?
- geometric removal of tissue-> aggressive tumors
- marginal: just alveolar process
What is partial resection?
- remove to leave gap-> large tumors
- must reconstruct
What is carnoy's soln?
chemical coagulation: 60% EtOH, 30% Chloroform, 10% acetic acid
What are indications for marsupialization?
- prevent injury, devitalization of teeth, erupt teeth
- difficult surgical access
- pathologic fracture
- med compromised
Which MRI is good for fluid contrast?
What are risk factors of oral cancer?
tobacco, HPV, EBV
What type of oral cancer does EBV increase risk?
Type II nonkeratinizing NPC (nasopharyngeal)
What kind of leukoplakia is premalignant?
What is most erythroplakia?
invasive carcinoma, carcinoma in-situ or sever dysplasia
Adv/disadv of surgery?
- physical remove, pathology, quick, no toxicity
- morbidity, anesthetic, may miss some
Adv/disadv of radiation?
- tx both cancer and adj areas, preserves appearance function, sick elderly more tolerable
- long, toxicities, no pathology evaluation
adv/disdv of chemo?
- systemic, presever appearance/function
- not effective for all, long tx, toxicity, no pathology eval
- not curative alone
What are access aproaches for oral cancer surgery?
- intaoral: no scarring, limited access
- lip-splitting: best access
- visor flap: neck scarring only, long incision.
What is en bloc resection?
- marginal: alveolar process
What is Weber-reguson?
access to maxilla, via insicion around nose up to orbit
What type of surgery is done if node metastasis?
composite resection, radical neck dissection (including CN XI), modified (excludes CN XI), selective
What is the process of grafting?
prepare recipient site, immobilize, prevent infection
What are the phases of osteogenesis?
- I: remaining living graft cells
- II: BMP mobilized pluripotent cells to use graft as framework
What are the phases of skin graftin?
- adhesion: fibrin
- nutritions: diffusion
- attachment: fibroblast
Types of flaps?
- flap, composite of skin never separated from vascular supply
- random pattern: 2-3:1 length to base
- axial: known vascular axis 4-5:1
- Musculocutaneous: dominant blood supply for entire muscle
- composite free flap
What is the biggest advance in H & N reconstruction?
- composite free flap: skin, fascia, muscle & bone supplied by vessels large enough for microvascular anastamosis
- Heals like fracture, not graft