Initial Procedure

• orientate the specimen(s) using the anatomical or surgeon's landmarks.

• ink only critical mucosal and deep resection margins. For glossectomy specimens and resections of retromolar trigone, the critical margins are usually the posterior limits with the lingual sulcus/tonsillar bed. In the tongue, tumour can unexpectedly involve the deep medial margin inferiorly and posteriorly in the floor of mouth/oropharynx by sarcolemmal spread of tumour along intrinsic muscle bundles in the tongue. To facilitate assessment of possible bone involvement, the periosteal limits of alveolar mucosa not in continuity with the underlying bone should be inked.

• with large or complex specimens or those with in-continuity resections of bone, e.g., resections of the retromolar trigone, sample the mucosal limits first by taking radial blocks (Figure 13.3).

• cut the specimen into 4mm-thick slices transversely (in the anatomical vertical plane).

• measurements:

- dimensions of mucosa, deeper tissue and other components, e.g., bone (cm).

Posterior end of rim resection Pterygomandibular raphe (ascending Ramus)

Gingiva from posterior X aspect of upper alveolus

Buccal mucosa

Buccal gingiva

Posterior end of rim resection Pterygomandibular raphe (ascending Ramus)

Buccal mucosa

Buccal gingiva

Soft palate

Tonsil

Tumour

Lingual gingiva

Anterior end of rim resection (alveolar process of mandible)

Soft palate

Tonsil

Tumour

Lingual gingiva

Anterior end of rim resection (alveolar process of mandible)

Posterior end of rim resection (ascending ramus of mandible)

Buccal mucosa

Anterior end of rim resection (alveolar process of mandible)

Buccal mucosa

Anterior end of rim resection (alveolar process of mandible)

Tonsil

Lingual gingiva

Figure 13.3. Resection of right retromolar trigone with rim resection of mandible. Suggested siting and orientation of tissue blocks for resection of retromolar trigone. (a) View from above. (b) View from lingual aspect.

Tonsil

Lingual gingiva

Figure 13.3. Resection of right retromolar trigone with rim resection of mandible. Suggested siting and orientation of tissue blocks for resection of retromolar trigone. (a) View from above. (b) View from lingual aspect.

- tumour anteroposterior length x width (cm).

maximum depth (cm) from reconstructed mucosal surface. distances to closest mucosal and deep surgical margins (cm).

- mucosal abnormalities (cm).

Description

• other plaque-like/ulcerated/fungating: usual type SCC. warty: well-differentiated SCC, verrucous carcinoma. polypoid: spindle cell SCC. white/thickened: in-situ lesions.

document local spread, e.g., to salivary gland, tonsil, bone. neck dissection, mandibular bone.

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