5.3 TONGUE
Carcinoma originates at the tip or along the free borders: Area
of hyperkeratosis develops first.
Later this develops into an ulcerated lesion with exophytic
undermined border.
Palpation detects hardness and indicates that invasion has
occurred beyond the ulcer.
Spread cancer of the tip of the tongue metastasises to
ipsilateral sub mandibular nodes and later the nodes at the angle
of the mandible are involved.
Forty percent have nodes at the time of presentation.
CLINICAL
The patient presents with :
- Pain
- Salivation
- Fixation of Tongue
- Dysphagias
- Difficulty in speech
- Foetor
Diagnosis
Multiple biopsies establish the diagnosis and the extent in large
tumours.
TREATMENT
T1NoMo lesions can be treated by radiotherapy or surgery as small
lesion is removed with 1.5 cm margin of healthy tissue all
around. Lesion of upto 1cm can be treated by interstitial radion
with Iridium192 wire.
Combined operation including wide resection of a small oral
lesion if they have nodes at the time of presentation, they
require radial neck dissection.
Treat all larger lesions with preoperative radiation therapy,
following this with a radical neck dissection and in continuity
excision of any residual cancer.
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