1. Oral cavity The majority of tumors in the oral cavity are s.c.c.

2. Oral Tongue Posterior limit=>circumvallate papillae Posterior limit=>circumvallate papillae Tumors of the tongue begin in the stratified epithelium of the surface Tumors of the tongue begin in the stratified epithelium of the surface

3. Presentation Ulcerated mass Ulcerated mass Oxophytic mass Oxophytic mass Regional lymphatics=>Submandibular space+Upper cervical lymph nodes Regional lymphatics=>Submandibular space+Upper cervical lymph nodes Lingual n.&Hypoglossal n. Lingual n.&Hypoglossal n. Lateral of the tongue and ventral surface Lateral of the tongue and ventral surface

4. Others tumors of tongue Leiomyomas Leiomyomas Leiomyosarcma Leiomyosarcma Rhabdomyosarcoma Rhabdomyosarcoma Neurofibroma Neurofibroma

5. Treatment Wide local excision Wide local excision Carbon dioxide laser Carbon dioxide laser Partial glossectomy Partial glossectomy Modify radical neck dissection Modify radical neck dissection Selective neck dissection Selective neck dissection

6. Salivary Gland Tumors Uncommon Uncommon <2%head&neck neoplasm <2%head&neck neoplasm Major salivary gland=>Parotid,Submandibular,Sublingual Major salivary gland=>Parotid,Submandibular,Sublingual Minor salivary glands=>throughout the submucosa of upper aerodigestive tract(highest density within the palate Minor salivary glands=>throughout the submucosa of upper aerodigestive tract(highest density within the palate

7. 85%of salivary gland neoplasm arise in the parotid 85%of salivary gland neoplasm arise in the parotid The majority are benign The majority are benign The most common histology is mixed tumor(pleomorphic adenoma) The most common histology is mixed tumor(pleomorphic adenoma) 50% of tumors of submandibular&sublingual are malignant 50% of tumors of submandibular&sublingual are malignant

8. Metastasis Histology Histology Primary site Primary site Stage of the tumor Stage of the tumor

9. Metastasis to: Parotid=>intra-and periglanular node&upper jugular nodes Parotid=>intra-and periglanular node&upper jugular nodes Submandibular=>prevascular facial L.N.&submental L.N.&upper and mid- jugularL.N. Submandibular=>prevascular facial L.N.&submental L.N.&upper and mid- jugularL.N.

10. Risk of metastasis High grade High grade Perineural invasion Perineural invasion Extraglandular spread Extraglandular spread Advanced age Advanced age

11. Diagnosis evaluation MRI MRI FNA(70-80%) FNA(70-80%)

12. Epithelial Epithelial Nonepithelial Nonepithelial Metastatic Metastatic

13. Benign epithelial tumors Pleomorphic adenoma (80%) Pleomorphic adenoma (80%) Monomorphic adenoma Monomorphic adenoma warthin`s tumor warthin`s tumor Oncocytoma Oncocytoma sebaceous sebaceous

14. Nonepithelial lesions Hemangioma Hemangioma Neural sheath tumors Neural sheath tumors lipoma lipoma

15. Treatment of benign neoplasn Surgical excision of affected gland (superficial parotiectomy) Surgical excision of affected gland (superficial parotiectomy)

16. Malignant epithelial tumors Low grade to high grade Low grade to high grade The most common malignant epithelial of s.g. is mucoepidermoid ca. The most common malignant epithelial of s.g. is mucoepidermoid ca. Adenoid cystic ca.(1.neural invasion 2.2 nd most common 3.high incidence of distal metastasis 4.the most common malignancy for minor s.g. Adenoid cystic ca.(1.neural invasion 2.2 nd most common 3.high incidence of distal metastasis 4.the most common malignancy for minor s.g. Malignant mixed tumor (high grade) Malignant mixed tumor (high grade)

17. Treatment Surgical excision Surgical excision Postoperative radiation therapy Postoperative radiation therapy

18. Indication for radiation therapy Extraglandular disease Extraglandular disease Perineural invasion Perineural invasion Direct invasion of regional structures Direct invasion of regional structures Regional metastasis Regional metastasis High grade histology High grade histology

19. Hypopharynx & cervical esophagus S.C.C. (advanced stage) S.C.C. (advanced stage)

20. Clinical findings Neck mass Neck mass Muffled or hoarse voice Muffled or hoarse voice Referred otalgia Referred otalgia Dysphagia (common symptom-solid to liquid) Dysphagia (common symptom-solid to liquid) Weight loss Weight loss Vocal cord paresis or paralysis (direct invasion of larynx) Vocal cord paresis or paralysis (direct invasion of larynx) Airway compromise Airway compromise

21. Work up Flexible fiberoptic laryngoscopy (extent of tumor) Flexible fiberoptic laryngoscopy (extent of tumor) Barium swallow Barium swallow CT,MRI CT,MRI

22. L.N. metastasis Bilateral metastatic adenopathy in the paratracheal chain is common Bilateral metastatic adenopathy in the paratracheal chain is common ¾ of patients have L.N. metastasis at the time of diagnosis ¾ of patients have L.N. metastasis at the time of diagnosis Poor prognosis

23. Treatment Definitive radiation therapy for smaller T1 – T2 tumors Definitive radiation therapy for smaller T1 – T2 tumors Surgery + postoperative radiation for advanced tumors Surgery + postoperative radiation for advanced tumors

24. Cervical esophagus Surgery Surgery Chemotherapy + external beam radiotherapy Chemotherapy + external beam radiotherapy 5-years survival rate < 20% 5-years survival rate < 20%

25. Larynx Smoking Smoking Prolonged hoarse voice Prolonged hoarse voice

26. Anatomy Supraglottic Supraglottic Glottic Glottic Subglottic Subglottic

27. Tumors of Larynx S.C.C. S.C.C. Neuroendocrine origin Neuroendocrine origin Squamous papilloma Squamous papilloma Granular cell T. Granular cell T. Tumor of salivary origin Tumor of salivary origin

28. Tumors of laryngeal framework Synovial sarcoma Synovial sarcoma Chondroma Chondroma Chondrosarcoma Chondrosarcoma

29. Symptoms of Supraglottic T. Chronic sore throat Chronic sore throat Dysphonia(Hot potato voice) Dysphonia(Hot potato voice) Neck mass(L.N. metastasis) Neck mass(L.N. metastasis) Vocal cord fixation Vocal cord fixation Muffled voice Muffled voice Reffered otalgia Reffered otalgia Odynophagia Odynophagia Airway compromise(bulky T.) Airway compromise(bulky T.)

30. Symptoms of glottic T. Hoarsness Hoarsness Airway Obstruction(late) Airway Obstruction(late)

31. Symptoms of subglottic T. Rare Rare Laryngeal paralysis (unilateral) Laryngeal paralysis (unilateral) Stridor Stridor pain pain

32. Vascular lesion Hemangioma Hemangioma Vascular malformation Vascular malformation

33. Hemangioma Infancy & childhood Infancy & childhood 30% present at birth 30% present at birth Proliferate Proliferate 40% resolve completely 40% resolve completely Surgery =>1.for those that have not significantly involuted by 3-4 years of age 2.severe functional problem (periorbital) 3.cosmetic problem (nasal tip) Surgery =>1.for those that have not significantly involuted by 3-4 years of age 2.severe functional problem (periorbital) 3.cosmetic problem (nasal tip)

34. Laser (4-6 weeks) Laser (4-6 weeks) Systemic steroid Systemic steroid

35. Evaluation CT CT MRI MRI Fiberoptic endoscopy Fiberoptic endoscopy Direct laryngoscopy (general anesthesia) Direct laryngoscopy (general anesthesia) Esophagoscopy Esophagoscopy bronchoscopy bronchoscopy

36. Treatment Small involvement: 1.laser ablation 2.conservative surgery Small involvement: 1.laser ablation 2.conservative surgery Advance: 1.partial laryngectomy 2.total laryngectomy Advance: 1.partial laryngectomy 2.total laryngectomy radiotherapy radiotherapy