3/2022 4/2022


Dear readers,

cancers of the oral cavity and oro­ pharynx are among the ten malignan­ cies with the most frequent occurrence in the human population (about 15% of the total number of malignant tumors). Worldwide, approximately 500,000 new cases of the disease occur each year. At the same time, only about one third of patients survive 5 years after diagnosis. The percentage share of these tumors in the total number of malignancies in the Czech Republic is around 2% (US 3%, Southeast Asian countries 35–40%).

Currently, the incidence of oropharyn­ geal malignancies is increasing in the younger generation (often occurring cancers in the fourth and third decades of life), the percentage of malignancies in women is increasing, as well as the number of distant metastases from ex­ traoral primary tumors. Currently, the malignancies of the oropharynx and oral cavity have also duplicity or multiplicity of occurrence.

In 90% of cases, they are malignant epithelial tumors, most often squamous cell (epidermoid) carcinoma. The re­ maining 10% include adenoid cystic car­ cinoma, mucoepidermoid and other sali­ vary gland adenocarcinomas, and then malignant lymphomas, rarely sarcomas. On the skin of the face, we most often encounter basal cell and squamous

cell carcinomas, melanomas, only ex­ ceptionally with some other rare malig­ nancies such as Merkel cell carcinoma. Conversely, malignant mesenchymal tu­ mors (with the exception of hematolog­ ical malignancies) are significantly rarer in the oropharyngeal region.

Histological verification of squamous cell carcinoma of the oral cavity and oro­ pharynx is usually not difficult. However, recognizing the early stages of invasion can be problematic for the pathologist, similarly to demonstrating bone inva­ sion and nodal micrometastases.

In the last few years, a number of clin­ ical and pathomorphological criteria have been established, which are now commonly used to determine histo­ pathological staging and are of key im­ portance for postoperative treatment and prognosis estimation of cancers of the oral cavity and oropharynx (tumor location and volume, histopathological grading, invasive tumor growth, histo­ logical type of squamous cell carcinoma, positivity of resected margins, presence of locoregional and distant metastases, bone invasion of the tumor into the oro­ facial skeleton)

The prognosis of a malignant tumor of the oral cavity and oropharynx is mainly determined by the degree of in­ vasiveness of the primary tumor and the extent of metastatic involvement of regional and distant nodes. The prog­

nosis of malignancies of the oral cavity and oropharynx depends primarily on early diagnosis, which is significantly in­ fluenced by the clinical experience and oncological awareness of doctors and the lay population.

The main goal of the surgeon is to achieve microscopically negative mar­ gins. The destructive phase should not be limited by concerns about whether and how the defect can be recon­ structed. When planning a surgical pro­ cedure, it is therefore necessary to take into account several points of view and find a reasonable compromise between them with an emphasis on preserving mastication, phonation, the act of swal­ lowing and aesthetics. In modern head and neck oncology, it represents the radical removal of the tumor followed by reconstruction of the associated vessel.

I believe that today’s issue of Acta chi­ rurgiae plasticae will be a useful contri­ bution to our knowledge of head and neck oncology and further evidence of the vitality of this journal.

Assoc. Prof. Richard Pink, MD, DMD, PhD

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