진행된 구강암과 설전절제술

Management of advanced oral cavity carcinoma is still challenging issues because it shows poor survival rate in spite of aggressive treatment and can create severe functional deficit after ablative resection. Despite of wide surgical resection combined with postoperative radiotherapy, the 5-year survival rate has remained unchanged over past 10 years period, due to high locoregional recurrence rate, distant metastasis, and multiple primary carcinoma. The patients requiring the extensive resection for the advanced oral cavity cancer often have failed other treatment modalities. Resection including the total tongue and the adjacent structures, such as the mandible or the larynx, create the complex structural deformity. Total glossectomy is the management of choice for advanced carcinoma of the floor of the mouth and the tongue. Particularly, total glossectomy with preservation of the larynx was not well accepted by the majority of the head and neck surgeons, because it always induce the potential risks for disruption of the deglutition and life-threatening aspiration as well as severe speech impairment. The purpose of reconstruction for total tongue defects is to restore swallowing without aspiration and regain intelligible speech. Many reconstructive options for this large defect have been introduced, there is still lack of reliable methods for proper functional restoration. Recently, the morbidity after major resection and rehabilitation have improved significantly with use of more innovative and reliable reconstruction. Total glossectomy can not provide a benefit in survival but may provides excellent palliation of symptoms and offers preferable locoregional control rates rather than radiotherapy or chemotherapy. However, it should only be undertaken in motivated and well-supported patients able to accomplish the difficult rehabilitation process. Therefore, treatment strategies should be decided based on proper patients selection and multidisciplinary team effort is essential for successful outcome. (J Clinical Otolaryngol 2003;14:56–64)