Surgery for squamous cell carcinoma of the tongue and floor of the mouth.

Surgery for cancer of the tongue and floor of the mouth has become more varied and generally more conservative, influenced by advances in oncology and modern reconstructive methods. Combined therapy is favored, with postoperative irradiation and sometimes adjunctive chemotherapy, using cis-platinum. T1 carcinomas of the tongue and floor of the mouth can be treated with either wide local excision or irradiation alone, but surgery is the preferred method. T2-T4 tumors treated by resection combined with radiation therapy promise the best results. The indications and principles of the most important operative procedures are discussed: local excision; partial and total glossectomy; excision of the floor of the mouth with marginal mandibular resection; composite resection. Mandible sparing operations such as a modification of the "pull through" technique described by Stell or temporary splitting of the mandible are oncologically safe in many cases. A radical neck dissection is indicated in each carcinoma of the tongue or floor of the mouth with palpable lymph nodes. If no nodes are palpable, an elective neck dissection appears justified in view of the high frequency of clinically occult lymph node metastases. Reconstructive measures following radical tongue and floor of the mouth operations are required for regaining mobility of the remaining tongue, for reconstruction of the floor of the mouth and for replacement of the mandible. For immediate reconstruction, the most frequently used technique is the pectoralis major myocutaneous flap which has largely replaced the previously employed local and regional flaps. A significant problem remains with mandibular reconstruction.