Abstract
The importance of preserving intact mandibular continuity in postoperative oral function is well recognized, although numerous advances in mandibular reconstruction and dental implant have been made.
The extent of resection of the mandibular bone is determined depending upon the clinicopathologic assessment of the tumor, such as the site, size and histologic type of the primary tumor, extent and pattern of mandibular invasion, and associated soft tissue involvement. For assessment of mandibular invasion, conventional radiography (dental, occulusal and panorex views), CT, MRI, and 201T1-99mTc dual SPELT are the preferred adjunctive diagnostic methods. 201T1-99mTc dual SPELT provides more specific information about early invasion of the mandible.
Patients with central cancer of the mandible can usually be treated by segmental mandibulectomy or hemimandibulectomy. Patients with tumor abutting on the mandible without apparent bony invasion may be treated by marginal resection. Patients with tumor radiographically showing erosive type of mandibular resorption may be treated by marginal mandibulectomy, and patients with tumor showing invasive type of bony resorption by segmental mandibulectomy or hemimandibulectomy. Patients who have had previous radiotherapy may be treated by segmental mandibulectomy or hemimandibulectomy.
In marginal resection, the periosteum all around the resected mandible is included in the surgical specimen, and “mandibular swing” approach is combined for lesions involving posterior oral cavity.
Intraoperative frozen section analysis of the deep soft tissue margins of resection is done, and cytological control of the margins of the mandible is also obtained to secure the safety.
