Small superficial cancers can be very successfully treated by local implantation using any one of several radioactive sources, by intraoral cone radiation therapy, or by electrons. Larger lesions are frequently managed using external-beam radiation therapy to include the primary site and regional lymph nodes even if they are not clinically involved. The choice of treatment is dictated by the anticipated functional and cosmetic results and by the availability of the particular expertise required of the surgeon or radiation therapist for the individual patient. Early cancers of the buccal mucosa are equally curable by radiation therapy or by adequate excision. Patient factors and local expertise influence the choice of treatment.
Larger cancers require composite resection with reconstruction of the defect by pedicle flaps.
Moderate excisions of tongue, even hemiglossectomy, can often result in surprisingly little speech disability provided the wound closure is such that the tongue is not bound down. If, however, the resection is more extensive, problems may include aspiration of liquids and solids and difficulty in swallowing in addition to speech difficulties. Occasionally, patients with tumor of the tongue require almost total glossectomy. Large lesions generally require combined surgical and radiation treatment. According to clinical and radiological evidence of involvement, cancers of the lower gingiva that are exophytic and amenable to adequate local excision may be excised to include portions of bone.