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Medicine LibreTexts

6.8.6: 6. Clinical Evaluation- History and Examination

  • Page ID
  • Objectives

    • Select appropriate surgery
    • Avoid unnecessary surgery
    • Avoid embarking on surgery that is beyond the scope of a surgeon

    Primary tumour

    • Site
    • Diameter
    • Depth of invasion (palpation)
      • >4mm, then treat the neck electively
      • 5-10mm: T2
      • >10mm: T3
    • Soft tissue invasion
    • Tongue mobility
    • Trismus
    • XIIn, Lingual nerve, mental nerve dysfunction
    • Mandible
      • If adherent, then assess mandible invasion
      • Dental caries if to receive radiation therapy

    Cervical nodes

    • Palpate the neck
    • Palpate Level 1b between a finger placed on the floor of mouth and another on the neck
      • To detect nodes
      • To distinguish between SMG and lymph node as nodes are lateral/superficial to SMG are generally palpable only with the finger on the neck, as opposed to a SMG mass that is palpable between both fingers
    • Palpable nodes in lymphatic basin: assume metastases
    • No palpable nodes
      • T1 <4mm depth: Watchful waiting
      • T1 >4mm depth, T2-4: Electively treat neck
    • Nodes outside lymphatic basin e.g. lateral cancer with contralateral nodes, then consider FNAC / nodal biopsy

    Synchronous Primary (upper aerodigestive tract, lungs)

    • History and office examination
    • Panendocopy
    • CXR / CT / PET