Abstract
Forty-two patients were diagnosed sugamous cell carcinoma of the lower alveolus and gingiva in our clinic during the five years between 1981 and 1985. Twenty-five out of these 42 patients were all previously untreated cases, and received a curative operation as initial therapy. Twenty-one patients (84%) out of these 25 patients were classified into Stage III or IV. Twenty-two patients underwent a segmental resection of the mandible and 3 patients operated by hemimandibulectomy. All twenty-five patients received simultaneously neck dissection.
Recurrence or metastases after initial treatment were found in 6 patient out of 25 patients Two out of these 6 patients had a recurrence in the primary sites alone. One of the 6 patients had a recurrence in the primary sites and neck region, one in the primary sites and distant metastases, and 2 distant metastases alone. We examined the direction of tumor invasion to the adjacent tissue for classification into four patterns. Three out of 4 patients who had a recurrence in the primary sites had a tumor extended to the buccal mucosa at the first visit. On the other hand, the patients whose tumor extended to the floor of the mouth at their first visit, showed no recurrence in their primary region after surgery.
Thirteen patients (52%) had histopathologically cervical metastases, and 12 patients (48%) had no metastases in the postoperative findings. Five out of 6 patients whose primary lesion extended to the buccal mucosa, had histopathologically positive lymph nodes. Nine out of 11 patients whose mandibular bone resorption was within the limit of alveolar crest showed pathologically positive lymph nodes, six out of 7 patients whose tumor invaded the mandibular canal showed pathologically negative lymph nodes. In four out of 13 patients who showed pathologically positive lymph nodes, metastases were observed in the level 3.
We would like to suggest that a segmental resection of the mandible or hemimandiblectomyshould be performed in all cases with total neck dissection, except those with a localizedsuperficial lesion without bone resorption of the mandible.
