and floor of mouth

Figure 11.1B) are inserted to the tumour-bearing structure at 12 mm intervals under fluoroscopic control. The most posterior gutter guide is inserted first and attempts are made to keep all subsequent gutter guides parallel with this. Three gutter guides (occasionally four) are inserted to treat the tumour with a 1 cm margin of normal tissue. Once the operator is satisfied about the geometry of the implant, iridium hairpins are then inserted into the gutter guides. The hairpin is pressed down using a surgical hook and then the gutter guides are removed. The iridium is secured to the dorsum of the tongue by a stitch around the crossbar of the hairpin. The length of hairpins depends on the size of the tumour but usually 4 cm long hairpins are inserted. A typical dose for a low dose rate implant is 65 Gy given over 6–7 days.

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