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Kim, Hyung Jun (2008): Surgical management of oral squamous cell carcinoma infiltrating mandible. Dissertation, LMU München: Faculty of Medicine
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Abstract

Progression of recent trends in mandible-preserving operations for the management of oral squamous cell carcinomas that infiltrate the mandible is rapid and accompanying studies give invaluable information concerning behavioral understanding of oral squamous cell carcinoma within the mandible. However, a large amount of sound osseous tissue is removed as part of partial mandibulectomy, because it is difficult to gain direct sight into the medullary portion and as a result of fear for residual tumor in this inaccessible space. Thus, needless defects are not seldom. For that reason, there still exists a strong demand for an operating protocol regarding precise surgical clearance which fulfills the surgeons' desire to be more conservative. Twenty-one with evidence of intraosseous tumor spread of 82 resected mandibles were radiologically and histologically reexamined to compare discrepancies among clinical, radiologic and histologic entities of oral squamous cell carcinoma infiltration. Size and location of primary tumor were dominant correlating factors of oral squamous cell carcinoma infiltration into the mandible and were statistically significant (p < 0.05). Larger tumors are more likely to infiltrate the mandible. Gingiva and retromolar trigone were the prevalent locations which facilitated tumor infiltration. Direct contact of the tumor on the attached mucosa usually provides portal of entry of the tumor through the cortex into the medullary space. Periodontal space in the dentate mandible is another possible portal of entry. Erosive-type infiltration is mostly seen in the shallower depth in early phase of infiltration and then followed by invasive type in the deeper portion of mandible. Infiltrating tumors usually do not exceed the limit of the primary on the mucosa, but it becomes unpredictable when inferior alveolar nerve related spread is once initiated. Five to 10 mm of surgical clearance is applicable to any surgical interventions regarding mandible infiltrating oral squamous cell carcinoma. However, thorough pre- and intra-operative attention should be put on the nerve related spread, extended resection of mandible is inevitable when nerve involvement is evident. A combination of orthopantomogram, computerized tomography and Tc-99m skeletal scintigraphy provide a good assessment of the tumor infiltration in the mandible. Distance measurement in orthopantomogram is reliable in localizing the tumor and in planning the surgical margin. An operating scheme based on the biologic behavior of oral squamous cell carcinoma within the mandible is devised as a result of this study.