Basic Surgical Principles and Techniques

The surgical management of oral cavity squamous cell carcinoma (OSCC) has evolved considerably over the last century. While the desire to achieve surgical cure has remained the highest priority, the emphasis of surgery has “de-escalated” from being radical toward more function-sparing approaches that confer greater importance to reconstruction and rehabilitation. This evolution has been aided by a number of scientific and technological advances including an improved understanding of disease behavior, more accurate imaging and staging techniques, safer and more advanced anesthesia, and the reliability of microvascular reconstructive techniques. The biological aggression of the tumor, represented by features such as nodal involvement with extracapsular spread (ECS), has the greatest influence on survival in patients with surgically resectable disease [1]. Despite recent advances, the ability to favorably influence biological aggression has not been proven. Therefore, in the current era of surgical oncology, surgeons may optimize the outcomes of patients with OSCC by focusing on the following principles: