The mouth (oral cavity) includes the lips, the front part of the tongue, the floor of the mouth, the gums, the inner cheeks and the hard palate. Cancers here usually start in the lining as squamous cell carcinomas. They are visible and can be found early, which makes a real difference to how much treatment is needed.
What it is
Surgery for oral cavity cancer removes the tumour with a margin of healthy tissue. Depending on where it is, the operation may be a partial removal of the tongue (partial glossectomy), removal of part of the floor of the mouth, of the gum with the underlying bone of the jaw (marginal or segmental mandibulectomy), or of part of the palate. Because oral cancers spread to the lymph nodes of the neck, a neck dissection is often part of the same operation, even when the nodes feel normal. When the defect is large, it is rebuilt at once with tissue from the forearm, thigh or lower leg (microvascular reconstruction).
Who it is for
Adults with a biopsy-proven cancer of the mouth or tongue, adults with a precancerous patch that needs removal, and people with a recurrence after earlier treatment.
Symptoms and diagnosis
An ulcer or sore in the mouth that has not healed within a few weeks, a lump or thickening, a white or red patch, pain on chewing or swallowing, loose teeth without a dental cause, numbness of the lip or tongue, or a lump in the neck should be examined. Tobacco and alcohol are the main risk factors. Diagnosis is made by examination and a biopsy taken in the consultation room or under anaesthesia. MRI or CT shows the depth of the tumour and the state of the jaw and the lymph nodes; a PET scan is used in selected cases.
How the operation is done
Under general anaesthesia, the tumour is removed through the mouth when it is accessible; larger tumours may require an approach through the neck or, rarely, a temporary division of the jaw. The neck lymph nodes are removed through a separate incision in a skin crease. When reconstruction is needed, a piece of skin, muscle or bone with its own blood vessels is taken from another part of the body and connected to the vessels of the neck under a microscope, so that it lives in its new position. A temporary tracheostomy (breathing opening in the neck) and a feeding tube are used when swelling is expected. The pathology report of the removed tissue determines whether radiotherapy is needed afterwards.
Recovery
Eating starts with liquids and soft foods, often through a tube for the first days after larger operations, and progresses as healing allows. Speech and swallowing therapy begins early. Numbness or a change in the shape of the tongue improves with time and practice. The donor site of a reconstruction heals over a few weeks. Regular follow-up examinations of the mouth and neck continue for years.
How Prof. Hafız works
Oral cavity and throat tumours, neck surgery and microvascular head and neck reconstruction are focus areas of Prof. Hafız’s practice. His published research includes work on oral squamous cell carcinoma and on the reconstruction of defects in the mouth and jaw. Treatment is planned so that removing the cancer completely and preserving the ability to eat and speak are considered together from the start.