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- ItemOpen AccessInferior Maxillectomy(University of Cape Town, 2025-03-08) Fagan, Johan; Fagan, JohanTumours of the hard palate and superior alveolus may be resected by inferior maxillectomy (Figure 1). A Le Fort 1 osteotomy may also be used as an approach to e.g. angiofibromas and the nasopharynx. A sound understanding of the 3-dimensional anatomy of the maxilla and the surrounding structures is essential to do the operation safely. Hence the detailed description of the relevant surgical anatomy that follows.
- ItemOpen AccessTotal Glossectomy for Tongue Cancer(University of Cape Town, 2025-05-18) Fagan, Johan; Fagan, JohanTotal glossectomy has significant morbidity in terms of intelligible speech, mastication, swallowing, and in some cases, aspiration. Consequently, many centers treat advanced tongue cancer with chemoradiation therapy and reserve surgery for treatment failures. Total glossectomy is however a very good primary treatment for carefully selected patients, especially in centers that do not offer chemoradiation. Key surgical decisions relate to whether the patient will cope with a measure of aspiration, and whether laryngectomy is required.
- ItemOpen AccessResection of Cancers of the Base of Tongue(University of Cape Town, 2025-03-03) Fagan, Johan; Fagan, JohanCancers of the base of tongue (BOT) may be treated with primary surgery, and/or irradiation, and/or chemoradiation therapy. Both the oncology team and patient need to carefully weigh up morbidity vs. cure of surgical and nonsurgical options, both of which may cause significant morbidity. Patients need to be carefully assessed relating to their ability to deal with a measure of aspiration, access to speech and swallowing services and to PEG feeding should they not resume oral feeding.
- ItemOpen AccessPartial Glossectomy for Tongue Cancer(University of Cape Town, 2025-03-08) Fagan, Johan; Fagan, JohanCancers of the tongue are generally treated with primary surgical resection. Adjuvant radiation is indicated inter alia for advanced tumours, tumours with perineural invasion (PNI) or uncertain/close margins. Resecting tongue cancer without considering subsequent oral function may severely cripple a patient in terms of speech, mastication, oral transport and swallowing. Resecting the anterior arch of the mandible beyond the midline without reconstructing bone and with loss of the anterior attachments of the suprahyoid muscles (digastric, geniohyoid, mylohyoid, genioglossus) causes an Andy Gump deformity with loss of oral competence, drooling, and a very poor cosmetic outcome
- ItemOpen AccessAccess to the Parapharyngeal Space(University of Cape Town, 2025-03-08) Fagan, Johan; Fagan, JohanThe parapharyngeal space (PPS) extends from the skull base above, to the hyoid bone below, and contains fat, the carotid artery, internal jugular vein, and the lower cranial nerves and sympathetic nerve. Surgical resection of tumours of the PPS requires a good understanding of the anatomy, likely pathology (if not known), and surgical approaches. The PPS extends as an inverted pyramid from the base of the skull superiorly, to the hyoid bone inferiorly. Figure 1 illustrates an axial view of the prestyloid (yellow) and poststyloid components of the PPS, separated by the styloid process, tensor veli palatini muscle and fascia stretching between (brown). The poststyloid space contains the internal carotid artery and the internal jugular vein, as well as the lower cranial nerves IX -XII, and the sympathetic trunk. It is confined medially by the pharyngobasilar fascia above, and the superior constrictor muscle of the pharynx.