Dentaltown March 2018 - 42
message board
Christmas Cancer
An oral surgeon shares a case that illustrates the importance of
performing thorough checks for head and neck cancer
toofache32
Member Since: 08/10/04
Post: 1 of 52
It seems like every December, I get a patient with head/neck cancer that I have to operate on,
so they spend Christmas in the hospital. This year I have three.
This poor guy had a lymph node in his neck start growing. A needle biopsy showed squamous cell carcinoma, which prompted a search to look for the source (usually tonsil or base of
tongue). Couldn't find the primary site, but this started to grow very quickly and soon began to
grow through his skin and was attached to his mandible. Strangely, he also had a huge lipoma in
his neck that went down under his sternocleidomastoid muscle (SCM) into the carotid sheath.
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 1: On the OR table after intubated and prepped.
Fig. 2: This MRI shows the lipoma (the large black mass) and the cancer (the white mass
at the top). The larynx is the white mass in the center and the airway is the black hole in
the middle of the larynx. Luckily, the cancer wasn't invading the larynx, so he got to keep
his voice box.
Fig. 3: After doing a trach and marking the planned margins of excision.
Fig. 4: The incision was made all the way around the mass. The lipoma was exposed
posteriorly, which is the yellow part. The lipoma had to be removed just to get access to
the deeper parts of the neck to remove the lymph nodes.
Fig. 5: The lipoma retracted anteriorly to expose the internal jugular vein (which is kind
of bluish with the glare on it). The cancer was attached to the lipoma, so it was all removed
together. The two retractors at the bottom are holding the SCM.
Fig. 6: A view from below after the mass was dissected off the strap muscles, carotid
sheath and SCM. It's now just tethered to the mandible. The carotid artery still has some
fascia over it, but you can sort of see the superior thyroid artery coming off and coursing
inferiorly. We ended up using it later.
Fig. 7: An osteotomy in the inferior border of the mandible where the tumor was attached
to the bone.
Fig. 8: This is after mobilizing the bone segment and rotating it downward. The marrow
can be seen in the bone. Perforated into the floor of the mouth, so I closed it.
42
MARCH 2018 // dentaltown.com
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