Dear K,

I have found that there is a good bit of overlap in services performed by oral surgeons and ENT's....and even, in some cases, plastic surgeons.

Which one is best depends on their training and experience. For example, our local oral surgeon is a dental professional, doing great work with difficult extractions and even some bone grafting. This particular man, in this small city, does not have the patient volume to give him the experience to deal with major cancer surgery. He did my biopsy, but he would not consider....nor would I have considered him.....for my surgery.

The same goes for the ENT's here. They might be helpful in diagnosing cancer and referring a patient to the larger centers, but they are not experienced enough to do the surgery and follow-up treatment.

I was referred to an Oral and Maxillofacial surgeon at our state medical school. He has both a DDS and an MD degree. He is well known nationwide, and he did a great job on my surgery, doing all of my extensive surgery without making an incision on the outside of my face (exc. for the neck dissection, of course.)

I had wanted to go to M.D.Anderson.....and will if I have any recurrence....but we had a snafu in communication. As it turns out, the doctors who do this work at MDA are ENT's, and they usually do a facial incision for surgery like mine, so I escaped that, just by chance.

I don't doubt that I received the very best surgery possible. And I feel that my surgeon was well-versed in follow-up care. I, fortunately, did not require radiation or chemo, according to national treatment guidelines, but it made me nervous not to have gone to a large cancer center with a team approach. This anxiety alone made me uncomfortable and pointed out the importance of having confidence in your treatment team.

Six months after my surgery, I went to MDA for some second opinions, to be certain that I had been treated in the most proper manner, and they agreed that I had been treated just as they would have.

My discomfort with not having gone to the large center taught me the value of having total confidence in one's treatment. That is a very important factor.

So.....once you get a diagnosis through your local ENT, my advice is to go then to a large center where they treat head and neck cancer all the time, and let them decide which specialty is best for your treatment.

I would NOT, personally, (and I am married to a physician) consent to being treated for oral cancer locally. In my opinion, there are not enough patients in a private practice to give a physician the experience he/she needs to treat this properly and thoroughly. You need the advantage of lots of experience, and the team approach. You want the advantage of having a physician who has the experience with tissue preservation, since any removal in the mouth involves tissue vital for oral function.

Sooooooo You asked for an opinion......I just couldn't resist giving you my full answer, since there is no one answer to which is more appropriate, the oral surgeon or the ENT. Your local ENT can biopsy and assist with the diagnosis, but you should then take your results to the CCC of your choice and let them take it from there. They will want to re-test your biopsy most likely. This is a comfort also, to be certain that you are on the right track.

Please let us know what the ENT says tomorrow. Good Luck!