Figure 9.12b. Following lip split and mandibulotomy the periosteum is found to be uninvolved and is stripped from the mandible, which is preserved.

larger soft tissue resections a thin pliable flap such as the radial forearm flap probably gives the best results in maintaining tongue mobility. Where the mandible has been resected a fibular flap (Rinaldo, Shaha, and Pellitteri et al. 2004) or deep circumflex iliac artery (DCIA) flap is appropriate.

Adjuvant radiation therapy is indicated for positive nodes, perineural invasion, extracapsular nodal spread, positive margins, and high-grade histology. Prognosis for these tumors is difficult to assess, as the literature is mostly composed of case reports and small series. Spiro (1995) reported only 3 of 18 patients (16.6%) dying of their tumor with a median follow-up of 74 months. However, Yu, Gao, and Wang et al. (2007) reported distant

Figure 9.13a. CT scan shows low-grade mucoepidermoid carcinoma of the right sublingual gland.

Figure 9.13b. This tumor was accessed via a lip split incision and mandibulotomy. Bilateral supraomohyoid neck dissections were undertaken, as can be seen in the surgical specimen.

Figure 9.13c. Cosmetic result of lip split incision. Patient is alive and tumor-free 13 years postoperatively.

metastases and local recurrence as the main cause of death with local recurrence rates of 30% and distant metastases 26.7%. In this series 56.7% of tumors were stage III.

It is reasonable to conclude that although 5-year survival from submandibular and sublingual gland cancer is reasonable, the high percentage of ACC found in these glands leads to a continuing decrease in survival at 10 years and beyond due to late local recurrence and distant metastases.

Figure 9.14b. Intraoral view of high-grade mucoepider- Figure 9.14d. A modified radical neck dissection and moid carcinoma fixed to the right mandible. hemimandibulectomy with lip split was performed.

Figure 9.14e. Postoperative panoramic film showing the reconstruction plate.

Figure 9.14f. Immediately post-chemoradiation.

Figure 9.14g. Mass in anterior mediastinum eroding sternum and manubrium.

Figure 9.14f. Immediately post-chemoradiation.

Figure 9.14h. Close-up view of manubrial mass. The patient died shortly thereafter due to lung metastases. Re-published with permission from Ord RA. 2000. Salivary gland disease. In: Fonseca R (ed.), Oral and Maxillofacial Surgery, Volume 5, Surgical Pathology. Philadelphia: W.B. Saunders Co., pp. 288-289 (Figures 10-21 a, b, c, d, e, f, g).

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