If a reconstructive surgical procedure is required, radiation therapy has the advantage of producing a relatively better functional and cosmetic result with intact skin and muscle innervation. Radiation therapy is usually selected for T2 lesions that have minimal infiltration to preserve speech and swallowing. Surgery is reserved for patients for whom radiation treatment failed. Neck dissection may be considered when primary brachytherapy is used. Deeply infiltrative lesions are best treated by surgery, radiation therapy, or a combination of both.
Radiation therapy is preferred if the lesion involves the commissure.
Surgery is preferred if tumor invades the mandible or maxilla. External-beam with or without interstitial radiation therapy should be considered postoperatively for larger lesions. Small lesions may be treated by intraoral resection with or without a rim resection of bone and repaired with a split thickness skin graft. Radiation therapy may be used for small lesions but results are generally better after surgery alone. For early lesions without detectable bone invasion, limited resection of the mandible is performed.