Mandibular lingual releasing approach to oral and oropharyngeal carcinomas

Resection of a carcinoma of the oral cavity or oropharynx requires adequate exposure for direct visual and bimanual examination. Transoral resection of tumors of the oral cavity using the "pull-through" procedure can be difficult due to interference by the circumoral tissue and mandibular arch. Exposure of carcinomas involving the base of tongue may require mandibulotomy or lateral mandibulectomy even when margin control does not mandate removal of the jaw. Alternatively, surgical techniques routinely used for exodontia and periodontal surgery can be applied to the creation of a mandibular lingual mucoperiosteal flap that allows for the entire tongue and floor of mouth to be delivered into the neck. Oral cavity and base of tongue lesions can then be resected with excellent direct visual and palpable control of margins, but without lip splitting, mandibulotomy or mandibulectomy.