1. Introduction

a. Incision

b. Platysma Flap Elevation

c. Posterior Elevation of the Neck Dissection

d. Anterior Border of the SCM

e. Dissection Level 2B

f. Dissection Level 2A and 3 Along the IJ Vein

g. Dissection on Level 1B on the Submandibular Region

h. Dissection of the Carotid Sheath

i. Dissection on Level 1A Anteriorly

j. Elevation of the Fibrofatty Tissue of the Strap Muscles

k. Dissection on Level 1B

l. Retraction of the Submandibular Gland Exposing the Lingual Nerve

m. Removal of the Specimen

n. Confirmation of Hemostasis

o. Confirmation of the Nerves' Integrity

p. Specimen Orientation on the Back Table

q. Drain Placements and Wound Closure

2. Supraomohyoid Neck Dissection

a. Surgical Approach and Marking

b. Injection with Local Anesthesia

c. Beginning of Circumferential Dissection Around the Tumor

d. Extraction of Premolar Tooth Located Along the Linear Margin

e. Dissection of the Greater Palatine

f. Removal of the Soft Tissue Component of the Tumor

g. Orientation of the Soft Tissue

h. Specimens for Frozen Section

i. Posterior Partial Maxillectomy

j. Buccal Fat Pad Advancement for Repair

k. Suturing of Buccal Fat Pad

3. Excision of Squamous Cell Carcinoma from the Right Posterior Maxilla

a. Addition of the Soft Tissue Reliner

b. Call with Pathologist

c. Obturator Fixation to Adjacent Teeth

4. Immediate Surgical Obturator Placement and Adjustments

5. Post-op Remarks

Surgery has been the first line of treatment for oral cavity cancer. After appropriate workup, the decision to include an ipsilateral or bilateral neck dissection is made. The patient presented here was diagnosed with a posterior maxillary alveolar tumor. The treatment plan included wide local excision of the tumor with total alveolectomy, reconstruction with a buccal fat pad advancement, and placement of surgical obturator. Additionally, an ipsilateral supraomohyoid neck dissection was performed due to the relative risk of regional metastases.

Watch this full-length, narrated surgical video of a squamous cell carcinoma wide local excision from the posterior maxilla with advancement of the buccal fat pad, obturator placement, and ipsilateral neck dissection.

Tufts University