Posterior Marginal Mandibulectomy in the Management of Cancer of the Oral Cavity and Oropharynx

Abstract

OBJECTIVE: To review a single institution's experience with posterior marginal (ramus) mandibulectomy for mandibular preservation in the management of patients with squamous cell carcinoma of the retromolar trigone or oropharynx. To review the history and surgical technique with emphasis on functional as well as oncologic outcomes.

STUDY DESIGN AND SETTING: Retrospective review at a tertiary care academic referral center from 1996 to 2002.

RESULTS: Between 1996 and 2002, 382 patients with squamous cell carcinoma of the oral cavity and oropharynx were surgically treated at the Loyola University Medical Center. Medical records were reviewed and 152 patients were identified who had some form of mandibular procedure (segmental resection, marginal resection, or mandibulotomy) performed in conjunction with their tumor resection. Eighteen posterior marginal mandibulectomies were performed for primary cancers of the retromolar trigone, tonsillar fossa, and/or base of the tongue. All patients received adjuvant radiotherapy. Bone invasion of the marginal mandibulectomy specimens by squamous cell carcinoma was observed in 2 cases, neither of which developed a local recurrence. Mean and median overall survivals were 41.4 and 37.5 months, respectively. Functional outcomes were determined by administering the University of Washington Quality of Life instrument administered at 12 months. Patients reported significant alterations in chewing, but all were able to maintain satisfactory oral intake and no patient required a gastrosotomy tube.

CONCLUSIONS: A posterior osteotomy of the mandibular ramus is a useful adjunct in the surgical treatment of cancer of the retromolar trigone or oropharynx. Negative surgical margins can be obtained even with focal invasion of mandibular bone. The loss of bone in this area does not significantly affect patients' appearance. Patients report deterioration in chewing following this procedure but are able to maintain a diet of solid food. (Otolaryngol Head Neck Surg 2003;129:713-9.)

Get full access to this article

View all access options for this article.

References

Petruzzelli

Brockenbrough

Vandevender

. The influence of reconstructive modality on cost of care in head and neck oncologic surgery Arch Otolaryngol—Head Neck Surg 2002;128:1377–80

Crile

. Carcinoma of the jaws, tongue, cheek, and lips Surg Gyn Obs 1923;36:159–62

DeLacure

. Special considerations in management of the mandible for cancer of the oral cavity Curr Opinion Otolaryngol—Head Neck Surg 1996;4:98–105

Collins

Saunders

. Excision of selected intraoral cancers by the use of sagittal inner table mandibulectomy Otolaryngol—Head Neck Surg 1987;97:558–66

Martin

. Cancer of the guns (gingivae) Am J Surg 1941;54:769–806

Lane

Buckmire

Mukherji

. Use of computed tomography in the assessment of mandibular invasion in carcinoma of the retromolar trigone Otolaryngol—Head Neck Surg 2000;122:673–7

McGregor

MacDonald

. Patterns of spread of squamous cell carcinoma to the ramus of the mandible Head Neck 1993;15:440–4

Byers

Anderson

Schwartz

. Treatment of squamous cell carcinoma of the retromolar trigone Am J Clin Oncol 1984;7:647–52

Petruzzelli

Vandevender

. Reconstruction of the tongue base Operative Tech Otolaryngol—Head Neck Surg 2000;11:158–65

10.

Hassan

Weymuller

. Assessment of quality of life in head and neck cancer patients Head Neck 1993;15:485–96

11.

Weymuller

Yueh

Deleyiannis

FWB

. Quality of life in patients with head and neck cancer: lessons learned from 549 prospectively evaluated patients Arch Otolaryngol—Head Neck Surg 2000;126:329–35

12.

Pinsolle

Truilhe

Majourfre

. Posterior marginal mandibulectomy for cancers of the oral cavity and oropharynx: experience with 14 clinical cases Ann Chir Plast Esthet 1997;42:223–7

13.

Werning

Byers

Novas

. Preoperative assessment for and outcomes of mandibular conservation surgery Head Neck 2001;23:1024–30

14.

Brown

Griffith

Phelps

. A comparison of different imaging modalities and direct inspection after periosteal stripping in predicting invasion of the mandible by oral squamous cell carcinoma Br J Oral Maxillofac Surg 1994;l32:347–59

15.

Tsue

McCulloch

Girod

. Predictors of carcinomatous invasion of the mandible Head Neck 1994;16:116–26

16.

Acton

CHC

Layt

Gwynne

. Investigative modalities of mandibular invasion by squamous cell carcinoma Laryngoscope 2000;110:2050–5

17.

Haribhakti

. The dentate adult human mandible: an anatomic basis for surgical decision-making Plast Reconstr Surg 1996;97:536–43

18.

McGregor

MacDonald

. Patterns of spread of squamous cell carcinoma within the mandible Head Neck 1989;11:457–61

19.

McGregor

MacDonald

. Spread of squamous cell carcinoma to the non-irradiated edentulous mandible—a preliminary report Head Neck 1987;9:157–61

20.

Brown

Lowe

Kalavrezos

. Patterns of invasion and routes of tumor entry into the mandible by oral squamous cell carcinoma Head Neck 2002;24:370–83