CHANGING TRENDS IN THE MANAGEMENT OF CARCINOMA OF THE ORAL CAVITY ANDOROPHARYNX

Two groups of patients with squamous cell carcinoma of the oral cavity and oropharynx treated by radical surgery were studied. Special empha sis was placed on analysing changing trends in reconstruction and the management of the mandible and their influence on complication rates, length of hospital stay and tumour control rates. Group 1 consisted of 97 patients treated between 1980 and 1984 and Group 2 consisted of 15 3 patients treated between 1987 and 1991. Anatomical distribution of c ancers and clinical stages were similar in the two groups. The major t rends identified were: (i) the increasing use of free flaps for recons truction (0 in Group 1, 41% in Group 2); (ii) more conservative mandib ular resection and the increasing use of mandibular swing procedures ( 1% in Group 1, 16% in Group 2) rather than segmental mandibular resect ion (44% in Group 1, 13% in Group 2); (iii) fewer procedures per patie nt (2.6 per patient in Group 1, 1.2 per patient in Group 2); and (iv) a decrease in mean duration of hospital stay from 34 to 16 days and fe wer complications. Patients in Group 2 also had a lower rate of local recurrence of cancer when compared with patients in Group 1 (19 vs 29% ).