Minimally invasive laser resection ensures the maximum preservation of oral soft tissue and thus the lubrication and mobility that only non-irradiated mucosa can supply. There is no need to divide the jaw for access. We maximize our chance to produce an articulating tongue, and facilitate the recovery of swallow. For these reasons, minimally-invasive laser resection may provide an indication for neck dissection before neck node disease is clinically evident. Similarly, the findings at laser excision may provide a reprieve from or the indication for radiotherapy.
Some bulky tumors turn out to be quite superficial, and some small tumors have iceberg extensions.
If the surgeon can be confident a superficial tumor is locally excised and there is little chance of neck disease, there is no need to invoke radiotherapy. Additional treatment is common in our series of patients, as many had local or neck indications for radiotherapy or neck dissection. The commonest contraindication to adjuvant radiation therapy was the fact it had previously been given. Prior radiotherapy has been the single most cogent factor in delayed wound healing or local treatment failure. On the other hand, post laser radiotherapy is well tolerated in previously untreated patients.