By Charles Staley (Editor), John E. Skandalakis (Editor), Sean Moore William C. Wood (Editor)
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Extra resources for Anatomic Basis of Tumor Surgery, 2nd Edition
Drainage is through the neck with suction drains through separate stab incisions. Mandibular Osteotomies Further exposure of the posterior oral cavity, oropharynx, parapharyngeal space, and skull base is obtained with transmandibular approaches, involving transection or segmental resection of the mandible. Mandibular osteotomies can be performed in the midline, paramedian (anterior to the mental foramen), or lateral (on the body or angle of the mandible) portions of the mandible or on the ascending ramus (posterior to the mandibular foramen).
Oropharynx Lymphatic vessels of these structures, especially the hard palate, are sparse compared with other sites in the oral cavity. Lymphatic drainage from the hard palate and lingual surface of the upper alveolus is to the upper jugular or lateral retropharyngeal nodes. The premaxilla also drains to the submandibular nodes. The buccolabial surface of the upper alveolus drains to the submandibular nodes. The sparse lymphatics draining the hard palate result in infrequent cervical metastases from malignancies of the hard palate (10–25%).
The mucosal incision can be carried superiorly along the anterior tonsillar pillar to include the tonsil or extended up onto the soft palate to access the superior parapharyngeal space. The mucosal incision can also be carried posteriorly through the palatoglossal fold and down the lateral pharyngeal wall at its junction with the base of tongue to the level of the hyoid bone. This provides excellent exposure of the base of tongue and valleculae. The tumor is visualized and the Bovie used to resect it with a 2-cm margin of normal tissue.
Anatomic Basis of Tumor Surgery, 2nd Edition by Charles Staley (Editor), John E. Skandalakis (Editor), Sean Moore William C. Wood (Editor)