Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology - head and neck working group

Table 5 Anatomical landmarks in contouring various oral subsites

Sub-site	Cranial	Caudal	Anterior	Posterior	Lateral	Medial
Oral tongue/ Floor of the Mouth (FoM)	Superior aspect tongue	Hyoid bone	Symphysis menti	Anterior oropharyngeal mucosa	To mandible. Includes ipsilateral parapharyngeal space	Ipsilateral tongue/FoM in well lateralized tumours. Contralateral mandible in midline or advanced tumours
Buccal mucosa	Inferior aspect zygomatic arch/hard palate	Hyoid bone	Angle of mouth	Oropharyngeal mucosa.	To overlying skin	Oropharyngeal mucosa. Contralateral parapharyngeal space spared
Buccal mucosa	Inferior aspect zygomatic arch/hard palate	Hyoid bone	Angle of mouth	Infratemporal fossa should be included in HNCPs with involvement or proximity to inferior alveolar nerve	To overlying skin
Retromolar Trigone	Superior aspect soft palate/hard palate	Hyoid bone	Junction of posterior third and anterior two thirds of the tongue	Oropharyngealmucosa	To mandible.	Oropharyngeal mucosa
					To mandible.	Contralateral parapharyngeal space spared
					Includes ipsilateral parapharyngeal space	Contralateral parapharyngeal space spared
Hard palate	Superior aspect of hard palate +10 mm	Hyoid bone	10-15 mm anterior margin on GTV into palate	Anterior aspect oropharyngeal mucosa	To mandible / medial pterygoid muscle on both sides. Includes both Parapharyngeal spaces.	To mandible/medial pterygoid muscle on both sides.
Hard palate	Superior aspect of hard palate +10 mm	Hyoid bone	10-15 mm anterior margin on GTV into palate	Anterior aspect oropharyngeal mucosa		Includes both parapharyngeal spaces.

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