SCCA of the Oral Cavity and the Oropharynx:SCC O C y O p yHow Imaging Can Make a Difference

Suresh K. Mukherji, M.D., F.A.C.R.Professor and Chief of NeuroradiologyProfessor and Chief of Neuroradiology

Professor of Radiology, Otolaryngology, Radiation Oncology, Periodontics and Oral MedicinePeriodontics and Oral Medicine

University of Michigan Health System

6th AJCC Staging6 AJCC StagingOropharynx

Tis: Carcinoma in situT1: Tumor < 2 cm in greatest dimensionu o c g eatest d e s oT2: Tumor 2 < 4 cm in greatest diameterT3: Tumor > 4 cm in greatest dimensionT3: Tumor > 4 cm in greatest dimension T4:

a Invasion of larynx deep/extrinsic muscle ofa. Invasion of larynx, deep/extrinsic muscle of tongue, medial pterygoid, hard palate or mandible

b. Invasion of lateral pterygoid muscle, pterygoid p yg , p ygplates, lateral nasopharynx, or skull base or encases the carotid artery

OropharynxOropharynx

Tongue Base

Tongue BaseTongue Base

Tongue BaseTongue Base

Orophar nOropharynx

Tongue Base

Tonsil

Anatomy:y“Tonsil”

TonsilTonsil

TonsilTonsil

OropharynxOropharynx

Tongue Base

Tonsil

Soft PalateSoft Palate

S ft P l tSoft Palate

S ft P l tSoft Palate

S ft P l tSoft Palate

R t h l L h N dRetropharyngeal Lymph Nodes

Retropharyngeal Lymph NodesRetropharyngeal Lymph Nodes

O liOutline

• Oropharynx

• Oral Cavity

AJCC/UICC Stagingg gOral Cavity

Tis: Carcinoma in situT1: Tumor < 2 cm in greatest dimensionT1: Tumor < 2 cm in greatest dimensionT2: Tumor 2 < 4 cm in greatest diameterT3: Tumor > 4 cm in greatest dimensionT3: Tumor > 4 cm in greatest dimensionT4:

a. Invasion through cortical bone, into deep extrinsica. Invasion through cortical bone, into deep extrinsic muscles of tongue, maxillary sinus, or skin of face

b. Invasion of masticator space, pterygoid plates, or skull base and/or encases internal carotid arteryskull base and/or encases internal carotid artery

O l C itOral Cavity

Buccal

B lBuccal

B lBuccal

O l C itOral Cavity

Buccal Space

Oral Tongue (“Mobile Tongue”)

Anatomy:y“Oral Tongue, MobileTongue”

O l TOral Tongue

“Wide Local Excision”

Crosses Midline

Deep Extension (Hyoglossus muscle): T4p ( y g )

Marginal (Rim) Mandibulectomyg ( ) y

T4: Deep Extension: Extrinsic Tongue Musclesp g

Hyoglossusy g

GenioglossusGenioglossus

O l C itOral Cavity

Buccal

Oral Tongue (“Mobile Tongue”)

Floor of Mouth (Sublingual Space)

Anatomy:y“Floor of Mouth, Sublingual Space”

Floor of MouthFloor of Mouth

Fl f M thFloor of Mouth

Fl f M thFloor of Mouth

O l C itOral Cavity

Buccal

Oral Tongue (“Mobile Tongue”)

Floor of Mouth (Sublingual Space)

Retromolar TrigoneRetromolar Trigone

Anatomy:Anatomy:“Retromolar Trigone”

R t l T iRetromolar Trigone

Anatomy:Anatomy:“Retromolar Trigone”

O l C itOral Cavity

Buccal

Oral Tongue (“Mobile Tongue”)

Floor of Mouth (Sublingual Space)

Retromolar TrigoneRetromolar Trigone

Hard Palate

Anatomy:yHard Palate

Hard PalateHard Palate

H d P l tHard Palate

Hard PalateHard Palate

Hard PalateHard Palate

Hard PalateHard Palate

Hard PalateHard Palate

SSummary

• Oropharynx

• Oral Cavity