**5. Conclusions**

*Human Papillomavirus*

**Figure 4.**

**Figure 5.**

*wider access.*

**26**

oral cavity, oropharynx, as well as hypopharynx and lateral cervical lymph nodes, parapharyngeal space, and masticator space and allows instrumentation of the

*mandibulotomy, with the two resulting mandibular pieces being pulled apart at different angles so as to permit* 

*Extensive external approach to a left side advanced (T4) tumor of the oropharynx and hypopharynx extending to the bony cortex of the mandible—with modified radical neck dissection and lateral* 

*External approach to a left side advanced oropharyngeal tumor, via mandibular "swing" demonstrating* 

*closure of the mandibulotomy using two titanium miniplates anchored with screws.*

Whichever surgical approach to the primary tumor the surgeon opts for, just as important as the complete excision of the tumor (the T) is the neck dissection. Tumors that do not pass the midline usually require ipsilateral lymph node dissection. However, bilateral neck dissection is sometimes required because of the vast network of lymphatics that drain the lateral pharyngeal area—most patients present

The alternative to surgical excision of the tumor is external intensity-modulated radiation therapy (IMRT) with or without adjuvant chemotherapy. This procedure has similar outcomes compared to surgery in cases of early-stage tumors but is slightly inferior compared to surgery when addressing advanced tumors. The dose delivered to the surrounding tissues is responsible for the toxicity and late adverse

entire oral cavity, making hard palate resections possible [21, 22].

with at least clinically N1 on diagnosis [23, 24].

As HPV infection is a growing concern worldwide, cases of HPV-positive oral and oropharyngeal carcinoma become more frequently encountered. Treatment options for this type of malignancy follow the same principles as for non-HPVpositive squamous cell carcinoma of the oral cavity and pharynx, consisting in surgery for locoregional control of the primary tumor and regional lymph nodes and radiation therapy—either as a stand-alone option or as an adjuvant therapy following surgical excision.

However, particularities of HPV-positive oropharyngeal cancer have led to a separation of this pathologic entity from the rest of squamous cell carcinomas involving the oropharynx. These tumors have a better outcome following treatment and thus treatment options were de-escalated to offer the same outcome and 5-year survival as well as less morbidity and a better quality of life.

New perspectives in treating the chronic HPV infection as well as preventing this infection by introducing efficient vaccination programs that target girls and boys also offer a positive future perspective on reducing malignancies associated with this viral infection, including those affecting the oral cavity and pharynx.
