Authors: Mette Hørberg, consultant in oral and maxillofacial surgery, Frederik Gulmark Hansen, med.stud., Magnus Balslev Avnstorp MD and Jytte Buhl, consultant in oral and maxillofacial surgery

Patient presentation

• Age, gender
• Medicine use
• Alcohol 
• Allergy
• General condition (other disease, co-morbidity)
• Current disease (time evolving of the tumour, bleeding, pain etc.) 
• Previous surgery or injuries to the limbs (arms and lower legs) incl. claudication and nerve disorders due to alcohol abuse or diabetes.
• History of lower limb DVTs
• Social status

Physical Examination 

Assessment of the oral cavity, face and neck including lymph nodes on the scalp, face and neck.

Tumour description: Location, size, distance to important structures i.e. lip, tongue, suspicion of deep infiltration in the submucosal complex (adhesion to underlying structures, and involvement of the skin), involvement of the mandibular bone.

Dental status

Examination of the arms and legs for consideration of reconstructive options. When considering a fibula free flap, the legs should be examined for scars, evidence of previous trauma, varicose veins, and the arterial supply should be palpated. 

Pre-operative assessment

The purpose of preoperative evaluation is to plan the best anaesthetic procedure based on the patient’s physiological limitations and to minimize risk to the patient by recognizing and optimizing comorbid conditions.

If the patient has an alcohol abuse an Alcohol Withdrawal Assessment Scoringis initiated and the withdrawal treatment is prescribed.

Tests:

• Stet-P
• Stet-C
• Blood samples
• CT neck and chest with contrast for cancer staging and for virtual planning

Pre-operative information to patient

• Placement of scars: lower lip/lip-splitting, neck incision – a transmandibular approach
• Tracheostomy
• Nasal gastric tube or PEG
• Change in face shape
• Risk of infection
• Bleeding
• Hematoma
• Bone necrosis
• Flap necrosis
• Seroma
• Trismus
• Oral incompetence
• Inhibition of speech
• Dysphagia