Table Of ContentOral, Head and Neck Oncology
and Reconstructive Surgery
R. Bryan Bell, MD, DDS, FACS, FACD
Medical Director
Providence Oral, Head and Neck Program and Clinic;
Fellowship Director
Head and Neck Oncologic and Microvascular Reconstructive Surgery
Providence Cancer Center at Providence Portland Medical Center;
Assistant Member
Robert W. Franz Cancer Research Center in the Earle A. Chiles Research Institute at Providence Cancer Center;
Clinical Professor
Oregon Health and Science University;
Director of Research
The Head and Neck Institute
Head and Neck Surgical Associates
Portland, Oregon
Rui P. Fernandes, MD, DMD, FACS
Associate Professor
Departments of Oral and Maxillofacial Surgery and Neurosurgery;
Chief, Division of Head Neck Surgery
Director of Head and Neck Oncologic Surgery and Microvascular Reconstructive Fellowship
University of Florida College of Medicine Jacksonville
Jacksonville, Florida
Peter E. Andersen, MD
Professor
Department of Otolaryngology–Head and Neck Surgery;
Professor
Department of Neurological Surgery
Oregon Health and Science University
Portland, Oregon
To all whose lives are inexorably touched by
the capriciousness of head and neck cancer:
your grace and tenacity inspire us to do better.
RBB
RPF
PEA
v
3251 Riverport Lane
St. Louis, Missouri 63043
ORAL, HEAD AND NECK ONCOLOGY AND RECONSTRUCTIVE SURGERY ISBN: 978-0-323-26568-3
Copyright © 2018 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and retrieval system, without permission in writing
from the publisher. Details on how to seek permission, further information about the Publisher’s permissions poli-
cies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing
Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than
as may be noted herein).
Notices
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any
information, methods, compounds or experiments described herein. Because of rapid advances in the medical sci-
ences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent
of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage
to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of
any methods, products, instructions, or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Names: Bell, R. Bryan, editor. | Fernandes, Rui P., editor. |
Andersen, Peter E., editor.
Title: Oral, head and neck oncology and reconstructive surgery /
[edited by]
R. Bryan Bell, Rui P. Fernandes, Peter E. Andersen.
Description: St. Louis, Missouri : Elsevier, [2018] | Includes
bibliographical references and index.
Identifiers: LCCN 2017023583 | ISBN 9780323265683 (hardcover :
alk. paper)
Subjects: | MESH: Head and Neck Neoplasms--surgery | Mouth
Neoplasms--surgery
| Reconstructive Surgical Procedures--methods
Classification: LCC RF51 | NLM WE 707 | DDC 617.5/1059--dc23 LC
record available at https://lccn.loc.gov/2017023583
Director, Content Development: Teri Hines-Burnham
Senior Content Strategist: Jennifer Flynn-Briggs
Publishing Services Manager: Julie Eddy
Senior Project Manager: Mary Stueck
Design Direction: Miles Hitchen
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Acknowledgments
I am fortunate to have been surrounded by individuals of Robert W. Franz Cancer Research Center in the Earle A.
much higher quality than myself ever since boyhood. At Chiles Research Institute at Providence Cancer Center; the
home, at school, and in my current profession—I am deeply Trauma Service at Legacy Emanuel Medical Center; and the
indebted to God, my family, friends, teachers, and colleagues Department of Oral and Maxillofacial Surgery at Oregon
who have provided me the license, opportunity, and mentor- Health and Science University.
ship necessary for a successful surgical career and a fulfill- To my parents, William and Sherry Bell, brother Adam Bell,
ing life. I am especially grateful to E. Craig Nemec, Bruce sisters Christine Foreman and Elizabeth Atkins, and parents-
Bordeleon, Don A. Hay, Gene R. Huebner, Wayne W. Bark- in-law Franklin and Karen Halvorsen—thank you for your
meier, Lawrence J. Sutton, Sean M. Cerone, Timothy A. Tur- unconditional love. To my wife and children whom I adore
vey, Raymond P. White, George H. Blakey, John R. Zuniga, and whose patience, gentleness, and love illuminate my path
Ramon L. Ruiz, Tinerfe J. Tejera, Shawn M. Conrad, Steven home at the end of a long day—Heidi, Harrison, and Caroline.
A. Bankston, Todd E. Zeigler, Eric J. Dierks, Bryce E. Potter, Thank you for my wonderful life.
William B. Long, Leon A. Assael, Robert W. T. Myall, Jason K. R. Bryan Bell
Potter, Kevin Arce, Joshua E. Lubek, Brian L. Schmidt, David
L. Hirsch, Shahrokh C. Bagheri, Andrew Christensen, Tuan To Candace, Gabriela, and Alessandro with love and
G. Bui, Allen C. Cheng, Ashish A. Patel, Melissa S. Amud- appreciation.
son, Michael R. Markiewicz, Walter J. Urba, Rom S. Leidner, Rui P. Fernandes
Bernard A. Fox, Andrew Weinberg, Marka R. Crittenden,
Michael J. Gough, Brendan D. Curti, Steven K. Seung, and To Susan, Molly, Katherine, and Matthew, my teachers and
Steven B. Bader for their tutelage, support, and unwavering especially to my patients for allowing me to be part of their
friendship; as well as the physicians, scientists, residents, fel- lives.
lows, nurses, surgical technicians, and administrators at the Peter E. Andersen
xx
Contributors
Laith Al-Qamachi, BDS, MFDSRCSEd, MBChB, FRCSEd Richard L. Bakst, MD
Department of Oral and Maxillofacial Surgery Assistant Professor
University Hospital–Birmingham NHS Foundation Trust Radiation Oncology
Birmingham, United Kingdom Ichan School of Medicine at Mount Sinai
Chapter 36: Soft Palate Cancer Mount Sinai Medical Center
New York, New York
Hemantha K. Amarasinghe, BDS, MSc, MD Chapter 34: Advanced HPV-Related Oropharynx Cancer
Consultant, Community Dentistry
Head of Research and Surveillance Unit Lauren E. Basile, DMD
Institute of Oral Health Chief Resident
Maharagama, Sri Lanka Department of Oral and Maxillofacial Surgery
Chapter 1: Epidemiology University of Washington
Seattle, Washington
Peter E. Andersen, MD
Chapter 27: Early Palatomaxillary Cancer
Professor
Department of Otolaryngology–Head and Neck Surgery; Andrew D. Beckler, MD
Professor
Center for Advanced Facial Plastic, Reconstructive, and
Department of Neurological Surgery
Cosmetic Surgery
Oregon Health and Science University
ENT Specialists
Portland, Oregon
Boynton Beach, Florida
Chapter 9: Management of the Neck
Chapter 10: Microvascular Surgery
Chapter 41: Subglottic Larynx Cancer
R. Bryan Bell, MD, DDS, FACS, FACD
Kevin Arce, DMD, MD, MCR
Medical Director
Assistant Professor of Surgery
Providence Oral, Head and Neck Program and Clinic;
Department of Surgery
Fellowship Director
Division of Oral and Maxillofacial Surgery
Head and Neck Oncologic and Microvascular Reconstructive
Mayo Clinic
Surgery
Rochester, Minnesota
Providence Cancer Center at Providence Portland Medical
Chapter 23: Early Oromandibular Cancer
Center;
Assistant Member
Varun Arya, DMD, BDS
Robert W. Franz Cancer Research Center in the Earle A.
Chief Resident
Chiles Research Institute at Providence Cancer Center;
Oral and Maxillofacial Surgery
Clinical Professor
Boston University Henry M. Goldman School of Dental
Oregon Health and Science University;
Medicine
Director of Research
Boston Medical Center
The Head and Neck Institute
Boston, Massachusetts
Head and Neck Surgical Associates
Chapter 22: Advanced Floor of Mouth Cancer
Portland, Oregon
Chapter 12: Maxillofacial Reconstruction and Prosthetic
Tomer Avraham, MD
Rehabilitation
Assistant Professor
Chapter 15: Immunotherapy
Plastic and Reconstructive Surgery
Chapter 24: Advanced Oromandibular Cancer
Mount Sinai Health System
Chapter 33: Early HPV-Related Base of Tongue Cancer
New York, New York
Chapter 35: Advanced HPV-Unrelated Pharynx Cancer
Chapter 7: Virtual Surgical Planning
vi
Contributors vii
Sandeep Bhuta, MBBS, DMRD, DNB, FRANZCR Lawrence E. Brecht, DDS
Neuroradiologist Director of Maxillofacial Prosthetics
Chief of Neuroradiology and Head and Neck Imaging Jonathan and Maxine Ferencz Postgraduate Program in
Department of Medical Imaging Prosthodontics
Gold Coast University Hospital College of Dentistry
Southport, Queensland, Australia New York University;
Chapter 44: Aggressive Non-melanoma Skin Cancer Director of Dental Services and Craniofacial Prosthetics
Hanjörg Wyss Department of Plastic Surgery
Carlo B. Bifulco, MD Langone Medical Center
Medical Director of Oncologic Molecular Pathology and New York University;
Pathology Informatics Institute of Reconstructive Plastic Surgery
Director of Translational Molecular Pathology New York, New York
Robert W. Franz Cancer Research Center in the Earle A. Chapter 7: Virtual Surgical Planning
Chiles Research Institute at Providence Cancer Center
Providence Health and Services James Brown, MD, FRCs, FDSRCS
Portland, Oregon Consultant, Maxillofacial and Head and Neck Surgeon
Chapter 2: Cellular and Molecular Pathology Head and Neck Directorate
Chapter 15: Immunotherapy Aintree University Hospital;
Consultant, Oral and Maxillofacial Surgeon
Gido Bittermann, MD, DMD Aintree University Hospital and Warrington Hospital
Senior Physician Professor of Head and Neck Surgery
Center of Dental Medicine Liverpool University
Department of Oral and Maxillofacial Surgery and Regional Liverpool, United Kingdom
Plastic Surgery Chapter 29: Advanced Palatomaxillary Cancer (Special
University Medical Center Considerations Related to Reconstruction)
Freiburg, Germany
Chapter 8: Intraoperative Navigation Chris J. Butterworth, BDS(Hons), MPhil, FDSRCS,
FDS(Rest), RCS
Keith E. Blackwell, MD Consultant, Oral Rehabilitation and Maxillofacial
Professor Prosthodontics
Section Chief of Facial Plastic and Reconstructive Surgery Head and Neck Directorate
Department of Head and Neck Surgery Aintree University Hospital;
David Geffen School of Medicine at University of Hon Senior Lecturer in Maxillofacial Prosthodontics
California–Los Angeles Department of Molecular and Clinical Cancer Medicine
Los Angeles, California University of Liverpool
Chapter 10: Microvascular Surgery Liverpool, United Kingdom
Chapter 29: Advanced Palatomaxillary Cancer (Special
Angel Blanco, MD Considerations Related to Reconstruction)
Director of Radiation Oncology
Memorial Hermann Cancer Center TMC Eric R. Carlson, DMD, MD, FACS
Houston, Texas Professor and Kelly L. Krahwinkel Chair
Chapter 25: Early Buccal Mucosa Cancer Director of Oral and Maxillofacial Surgery Residency
Program
Alexander M. Bobinskas, BSc, MBBS, B Oral Health Department of Oral and Maxillofacial Surgery
(Dental Science), Grad Dip Dentistry, MPhil, University of Tennessee Medical Center;
FRACDS(OMS), FRCS(OMFS) Director of Oral/Head and Neck Oncologic Surgery
Oral and Maxillofacial Surgeon Fellowship Program
Maxillofacial Surgery Department University of Tennessee Cancer Institute
Gold Coast University Hospital Knoxville, Tennessee
Southport, Queensland, Australia Chapter 31: Lip Cancer
Chapter 44: Aggressive Non-melanoma Skin Cancer
Keith A. Chadwick, MD
Caroline Brammer, MBChB(Sheff), MRCP, FRCR Resident Physician
Consultant, Clinical Oncology Department of Otolaryngology–Head and Neck Surgery
The Clatterbridge Cancer Centre–Aintree Oregon Health and Science University
Liverpool, United Kingdom Portland, Oregon
Chapter 29: Advanced Palatomaxillary Cancer (Special Chapter 39: Early Glottic Larynx Cancer
Considerations Related to Reconstruction)
viii Contributors
Srinivasa R. Chandra, MD, BDS, FDSRCS Brendan D. Curti, MD
Assistant Professor Director of Biotherapy and Genitourinary Oncology Research
Department of Maxillofacial–Head and Neck Oncologic and Earle A. Chiles Research Institute
Reconstructive Microvascular Surgery Providence Cancer Center
University of Washington Portland, Oregon
Seattle, Washington Chapter 43: Melanoma
Chapter 27: Early Palatomaxillary Cancer
Derfel ap Dafydd, BSc, MBBCh, MRCP, FRCR
Allen Cheng, MD, DDS Consultant, Radiologist
Medical Director Imaging Department
Oral, Head and Neck Cancer Program The Royal Marsden NHS Foundation Trust
Legacy Good Samaritan Medical Center London, England
Legacy Health; Chapter 42: Major Salivary Gland Cancer
Section Chair
Oral and Maxillofacial Surgery Roi Dagan, MD, MS
Legacy Emanuel Medical Center; Assistant Professor
Attending Surgeon Department of Radiation Oncology
Providence Oral, Head and Neck Cancer Program University of Florida College of Medicine
Providence Portland Medical Center; University of Florida Health Proton Therapy Institute
Consultant Jacksonville, Florida
The Head and Neck Institute Chapter 20: Advanced Tongue Cancer (Special Considerations
Head and Neck Surgical Associates Requiring Total Glossectomy)
Portland, Oregon Chapter 30: Advanced Palatomaxillary Cancer (Special
Chapter 12: Maxillofacial Reconstruction and Prosthetic Considerations Related to Nasal Involvement)
Rehabilitation
Chapter 24: Advanced Oromandibular Cancer Camilla Dawson, BSC (Hons), MRCSLT, HCPC
Chapter 33: Early HPV-Related Base of Tongue Cancer Clinical Lead Speech and Language Therapist
Chapter 35: Advanced HPV-Unrelated Pharynx Cancer Queen Elizabeth Hospital Birmingham
Birmingham, United Kingdom
Scott Claiborne, DDS, MD Chapter 36: Soft Palate Cancer
Fellow in Oral/Head and Neck Oncology and Reconstructive
Surgery Eric J. Dierks, MD, DMD
North Memorial Medical Center Director of Fellowship in Head and Neck Oncologic and
Minneapolis, Minnesota Microvascular Reconstructive Surgery
Chapter 21: Early Floor of Mouth Cancer The Head and Neck Institute
Head and Neck Surgical Associates;
Daniel R. Clayburgh, MD, PhD, FACS Attending Surgeon
Assistant Professor Oral, Head and Neck Cancer Program
Otolaryngology–Head and Neck Surgery Legacy Good Samaritan Medical Center
Oregon Health and Science University Legacy Health;
Portland, Oregon Attending Surgeon
Chapter 3: Molecular Biology Providence Oral, Head and Neck Cancer Program;
Chapter 40: Advanced Larynx Cancer Affiliate Professor
Chapter 41: Subglottic Larynx Cancer Oral and Maxillofacial Surgery
Oregon Health and Science University
Marka R. Crittenden, MD, PhD Portland, Oregon
Radiation Oncologist Chapter 12: Maxillofacial Reconstruction and Prosthetic
Director of Translational Radiation Research Rehabilitation
Providence Health and Services Chapter 35: Advanced HPV-Unrelated Pharynx Cancer
Robert W. Franz Cancer Research Center in the Earle A.
Chiles Research Institute at Providence Cancer Center Jasjit K. Dillon, DDs, MBBS, FDSRCS, FACS
Portland, Oregon Clinical Associate Professor and Program Director
Chapter 33: Early HPV-Related Base of Tongue Cancer Oral and Maxillofacial Surgery
University of Washington
Seattle, Washington
Chapter 27: Early Palatomaxillary Cancer
Contributors ix
Donita Dyalram, DDS, MD, FACS Rui P. Fernandes, MD, DMD, FACS
Assistant Professor Associate Professor
Associate Program Director/Associate Fellowship Director Departments of Oral and Maxillofacial Surgery and
Department of Oral and Maxillofacial Surgery Neurosurgery;
University of Maryland Medical Center Chief, Division of Head Neck Surgery
Baltimore, Maryland Director of Head and Neck Oncologic Surgery and
Chapter 18: Early Tongue Cancer Microvascular Reconstructive Fellowship
University of Florida College of Medicine Jacksonville
Sean P. Edwards, DDS, MD Jacksonville, Florida
Clinical Associate Professor Chapter 20: Advanced Tongue Cancer (Special Considerations
Director, Residency Program Requiring Total Glossectomy)
Chief, Pediatric Oral and Maxillofacial Surgery Chapter 30: Advanced Palatomaxillary Cancer (Special
Department of Oral and Maxillofacial Surgery/Hospital Considerations Related to Nasal Involvement)
Dentistry
University of Michigan Health System Jay K. Ferrell, MD
Ann Arbor, Michigan Resident Physician
Chapter 28: Advanced Palatomaxillary Cancer Otorhinolaryngology—Head and Neck Surgery
University of Texas Health Science Center at Houston School
David A. Elliott, MD of Medicine
Assistant Professor Houston, Texas
Radiation Oncology Chapter 32: Early HPV-Related Tonsil Cancer
University of Toledo Medical Center
Toledo, Ohio Bernard A. Fox, PhD
Chapter 13: Radiation Therapy Harder Family Endowed Chair for Cancer Research
Chapter 40: Advanced Larynx Cancer Chief of Laboratory of Molecular and Tumor Immunology
Chapter 41: Subglottic Larynx Cancer Robert W. Franz Cancer Research Center
Earle A. Chiles Research Institute
Mererid Evans, PhD, FRCR Providence Cancer Center, Knight Cancer Institute
Consultant, Clinical Oncologist Department of Molecular and Immunology
Velindre Cancer Centre Oregon Health and Science University
Cardiff, Wales, United Kingdom Portland, Oregon
Chapter 38: Advanced Supraglottic Larynx Cancer Chapter 15: Immunotherapy
Adam P. Fagin, DMD, MD Clifton D. Fuller, MD, PhD
Resident Assistant Professor
Department of Oral and Maxillofacial Surgery Department of Radiation Oncology
Oregon Health and Science University Division of Radiation Oncology
Portland, Oregon The University of Texas MD Anderson Cancer Center
Chapter 26: Advanced Buccal Mucosa Cancer Houston, Texas
Chapter 32: Early HPV-Related Tonsil Cancer
Carole Fakhry, MD, MPH
Associate Professor of Otolaryngology-Head and Neck Surgery G.E. Ghali, DDS, MD, FACS, FRCS(Ed)
Johns Hopkins University School of Medicine Gamble Professor and Chairman
Baltimore, Maryland Department of Oral and Maxillofacial Surgery
Chapter 1: Epidemiology Louisiana State University Health Sciences Center
Shreveport, Louisiana
Mark B. Faries, MD, FACS Chapter 19: Advanced Tongue Cancer
Professor of Surgery
Director of Donald L. Morton Melanoma Research Program John P. Gleysteen, MD
John Wayne Cancer Institute Assistant Professor
Santa Monica, California Department of Otolaryngology
Chapter 43: Melanoma University of Tennessee Health Science Center
Memphis, Tennessee
Zipei Feng, PhD Chapter 40: Advanced Larynx Cancer
Department of Cell, Developmental and Cancer Biology
Oregon Health and Science University
Portland, Oregon
Chapter 15: Immunotherapy
x Contributors
Kathryn A. Gold, MD Bronwyn Hamilton, MD
Associate Professor Associate Professor of Radiology
Moores Cancer Center Radiology Department
University of California San Diego Oregon Health and Science University
La Jolla, California Portland, Oregon;
Chapter 32: Early HPV−Related Tonsil Cancer Adjunct Assistant Professor of Radiology
Radiology Department
James Good, MSc, MD, PhD University of Utah
Consultant, Oncologist Salt Lake City, Utah
Queen Elizabeth Hospital Chapter 5: Diagnostic Imaging
Birmingham, United Kingdom
Chapter 36: Soft Palate Cancer Eric K. Hansen, MD
Radiation Oncology
Jennifer R. Grandis, MD Oregon Clinic
American Cancer Society Professor Providence St. Vincent Medical Center
Associate Vice Chancellor Portland, Oregon
Clinical and Translational Research Director Chapter 13: Radiation Therapy
Professor
Otolaryngology—Head and Neck Surgery Heidi J. Hansen, DMD, DABOM
University of California Assistant Professor of Surgery
San Francisco, California Division of Dentistry, Oral and Maxillofacial Surgery
Chapter 3: Molecular Biology Weill Cornell Medicine
New York, New York
Donna J. Graville, PhD, CCC-SLP Chapter 16: Oral/Dental Oncology
Associate Professor
Director of NW Center for Voice and Swallowing Bruce H. Haughey, MD, FACS
Otolaryngology/Head and Neck Surgery Otolaryngology
Oregon Health and Science University Florida ENT Surgical Specialists
Portland, Oregon Celebration, Florida
Chapter 17: Speech Pathology and Rehabilitation Chapter 4: Oncoviruses
Neil D. Gross, MD, FACS Richard E. Hayden, MD, FACS, FRCS(C)
Associate Professor Professor
Director of Clinical Research Department of Otolaryngology–Head and Neck Surgery
Head and Neck Surgery Mayo Clinic Arizona
University of Texas MD Anderson Cancer Center Phoenix, Arizona
Houston, Texas Chapter 37: Early Supraglottic Larynx Cancer
Chapter 32: Early HPV-Related Tonsil Cancer
Joseph I. Helman, DMD
Aaron Grossberg, MD, PhD C.J. Lyons Endowed Professor
Clinical Resident Oral and Maxillofacial Surgery
Department of Radiation Oncology University of Michigan
University of Texas MD Anderson Cancer Center Ann Arbor, Michigan
Houston, Texas Chapter 28: Advanced Palatomaxillary Cancer
Chapter 32: Early HPV-Related Tonsil Cancer
David L. Hirsch, MD, DDS, FACS
Shan Guo, MD Clinical Assistant Professor
Assistant Professor Oral and Maxillofacial Surgery
Division of Oncology College of Dentistry
Department of Internal Medicine New York University
University of Texas Health Science Center at Houston New York, New York
Houston, Texas Chapter 7: Virtual Surgical Planning
Chapter 25: Early Buccal Mucosa Cancer
