Preoperative assessment for and outcomes of mandibular conservation surgery

Introduction. The role of marginal mandibulectomy and other conservative re sective procedures for patients with early cortical mandibular invasion fro m squamous carcinoma of the oral cavity remains poorly defined. The purpose of this retrospective study was to evaluate the efficacy of preoperative a ssessment for bone invasion and the outcomes of different mandibular resect ive procedures that preserve mandibular continuity. Methods. The charts of 222 patients treated at the University of Texas M. D . Anderson Cancer Center between 1960 and 1990 were reviewed. All patients had a biopsy-confirmed diagnosis of squamous carcinoma involving either the lower gingiva, floor of mouth, oral tongue, or retromolar trigone. All pat ients had a surgical resection that involved removing less than a segment o f the mandible. Patient data were analyzed to determine the usefulness of p reoperative assessment and outcomes of therapy. Results. Clinical evaluation of mandibular bone invasion was more sensitive than radiologic evaluation, whereas radiologic assessment was more specifi c and had a higher reliability index. The overall local and regional recurr ence and distant metastasis rates for all T stages were 14.4%, 18.0%, and 2 .7%, respectively. Sixty-nine point eight percent of all patients were with out evidence of disease 2 years after treatment. Conclusions. Mandibular conservation surgery is oncologically safe for pati ents with early mandibular invasion. Accurate preoperative assessment that combines clinical examination and radiographic evaluation is better than ei ther modality alone, but clinical judgment is still necessary for proper pa tient selection. (C) 2001 John Wiley & Sons, Inc.