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242 Otolaryngology-Head and Neck Surgery completion of a comprehensive neck dissection, or radiation therapy to neck N13 Neck: radical neck dissection for clinical nodes; parotid nodes require a superficial parotidectomy Advanced Oral Cancer (T3T4) Single-Modality Therapy: excision of primary tumor with primary reconstruction (see below) versus primary radiation for nonoperable candidates (external beam versus brachytherapy) N0 Neck: elective ipsilateral or bilateral (midline or oral tongue cancer) selective neck dissection (supraomohyoid) versus external beam therapy; if surgical specimen is positive for tumor may consider observation, completion of a comprehensive neck dissection, or radiation therapy to neck N13 Neck: radical neck dissection for clinical nodes; parotid nodes require a superficial parotidectomy Adjuvant Therapy: postoperative radiation therapy may be considered for positive margins; multiple positive neck nodes or extracapsular extension; perineural or intravascular invasion; or bone, cartilage, or soft tissue invasion chemotherapyindicatedforpalliationormaybeconsideredfor adjuvant treatment for advanced disease Lip Cancer Single-Modality Therapy: excision of primary tumor (may consider Mohs micrographic excision) with primary reconstruction versus primary radiation therapy (5,0007,000 cGy) for small tumors or nonoperable candidates (must also consider functional and cosmetic outcomes) Adjuvant Therapy: postoperative radiation therapy may be considered for advanced stages (T34, N23), close or positive margins, multiple positive neck nodes, perineural or intravascular invasion, or extracapsular extension N0 Neck: elective ipsilateral or bilateral (for lower lip midline disease) selective neck dissection (supraomohyoid) versus external beam therapy for advanced diseases (T3T4); if surgical specimen is positive for tumor may consider observation, completion of a comprehensive neck dissection, or radiation therapy to neck N13 Neck: radical neck dissection for clinical nodes; parotid nodes require a superficial parotidectomy chemotherapymaybeconsideredforpalliationoradjuvant treatment medomak river trading post advanced disease 632 IV Registration 6 Summary We have described an image-guided neurosurgery system, now in use in the operating room.
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