Review of segmental and marginal resection of the mandible in patients with oral cancer

This paper reviews the medical literature of the last decade to ascertain t he criteria used to assess mandibular invasion by cancer of the oral cavity and to suggest how best to evaluate the mandible with a view to surgical m anagement. It is generally agreed that patients with mandibular invasion sh ould be treated surgically, but the extent of mandibular resection required remains a controversial matter and the accurate preoperative determination of neoplastic invasion of the mandible remains a challenge for head and ne ck surgeons. The relative reliability of preoperative orthopantomography, ( OPG) bone scanning, computed tomography (CT) and magnetic resonance imaging (MRI), and of peroperative periosteal stripping and direct inspection in c linical assessment for mandibular surgery, is discussed. The histological p atterns of tumor invasion and the most common routes of tumor entry in the mandible are described and the influence of variables such as prior radioth erapy and an edentulous vs a dentate state in relation to perineural invasi on are also discussed. Finally, a comparison is drawn between the reported outcome of marginal vs segmental resection procedures and a decision-making algorithm is proposed. In selected cases, marginal mandibulectomy can ensu re satisfactory tumor control, with a favorable effect on the morbidity ass ociated with mandibular surgery.