eRadiograph Volume 7: Imaging of Oral Cavity | Page 16

sagittal plane to evaluate extension to base of tongue. Superficial mucosal
lesions are often not visualized at imaging. The extent of mucosal spread in these is
assessed by direct clinical visualization. The role of imaging is to demonstrate deeper
extension into the submucosal region as physical examination underestimates the
extent of disease as well as any neck adenopathy.

Osseous involvement is similar to gingivobuccal carcinoma. Degree of osseous
involvement dictates the extent of resection required for appropriate oncologic
control.
Generally:
• If the lesion is mobile-wide, excision with resection of periosteum is performed.
• If the lesion is fixed and attached with minimal cortical erosion - marginal
mandibulectomy is performed.
• If there is gross cortical/neural involvement - segmental mandibulectomy with
reconstruction is performed.
False positive for osseous involvement maybe tooth extraction, radiation induced
fibrosis or osteonecrosis.
Lymphatic Dissemination
Level 1 and 2 nodes are first involved; approximately 40% in oral tongue and 65% in
base of the tongue. There maybe small lesions at level 3/4, therefore generally neck
dissection is performed from level 1-4. There is significant cross drainage of lymphatics
in oral tongue - bilateral cervical lymph node involvement is common.
Treatment of tongue carcinoma is either surgery or radiotherapy, the results are similar.