Surgical Approach to the Oral Cavity: Techniques, Advantages and Disadvantages of Pull Through Approach

Choi, Eun Chang; Koh, Yoon Woo; Lee, Yong Hoon; Park, Hyun Jung; Lee, Kwang Hyun

Abstract

BACKGROUND AND OBJECTIVES: The pull-through approach is one of the surgical approaches for oral cavity cancer, but the reports on its surgical experiences, indications, advantages and disadvantages are lacking.
PATIENTS AND METHODS
Fourteen patients of oral cavity and base of tongue cancer who had been treated with the pull-through approach at Severance Hospital from 1994 to 2000 were evaluated retrospectively using their surgical records and pathological reports. All patients had excision of primary tumor and bilateral neck dissection.
RESULTS
Total glossectomy was performed with the pull-through approach in four cases of oral cavity or base of tongue cancer. Partial glossectomy or excision of floor of mouth was done with this approach in ten cases of oral cavity cancer. In three patients, partial mandibulectomy was combined with primary extirpation without lip-splitting incision. In all but one case, primary tumor and neck specimen could be removed en bloc. Surgical margins were negative in all cases. Postoperative cosmetic results were satisfactory.
CONCLUSIONS
The pull-through approach is one of the useful surgical approach to oral cavity cancer. Especially, the pull-through excision is the choice of approach for total glossectomy. This approach is indicated in most of the oral cavity and the floor of mouth carcinoma with anterior location. It is contraindicated in patients with tumor extended to posterior part of tongue or oropharynx. En bloc excision of intraoral tumor and neck nodes without splitting lower lip or mandible is the major advantage of this approach.