Routes of entry of squamous cell carcinoma to the mandible

Abstract

A recent preliminary report of a study to determine the patterns of invasion of squamous cell carcinoma to the nonirradiated edentulous mandible indicated that tumor entered mainly through the residual alveolar occlusal ridge.' This study has now been extended and includes both nonirradiated and irradiated mandibles. Of a total of 46 nonirradiated mandibles (10 partially dentate and 36 edentulous) invaded by tumor, 41 were invaded through the occlusal surface. This confirms the findings of the preliminary report. These findings indicate that there is a rational basis on pathologic grounds for adopting a conservative approach to the nonirradiated mandible. In 16 irradiated mandibles, the routes of tumor entry were found to be much more variable than in the nonirradiated mandible, and multiple foci of tumor invasion of the bone were often present wherever tumor in adjacent soft tissues approached the bone. This variability of tumor entry means that a conservative approach to mandibular excision cannot be pursued in the previously irradiated mandible and full-thickness segmental resection is necessary if bone involvement appears likely. HEAD & NECK SURGERY 10: 294-301,1988

Prognostic impact of marginal mandibulectomy in the presence of superficial bone invasion and the nononcologic outcome

“…7 However, care must be exercised in edentulous patients in whom the tumor may migrate into the mandible through the dental pits. [8][9][10] indicates that the tumor enters the mandible at the site of primary tumor abutment; however, this does not apply in the previously irradiated bone, which could show multiple entry points because of the impaired barrier-like function of the periosteum and the osteoblastic activity. 8 Thus previously irradiated mandible should be best managed by segmental mandibulectomy.…”

“…Although some authors disagree with the periosteal stripping to assess tumor depth, which defies the traditional rationale of an enbloc resection, 15 most authors support the use of the stripping method. 1,5,7,8,16 Nevertheless, formal histologic assessment is routinely required to confirm the presence and the extent of bone invasion. Marginal mandibulectomy enables the primary tumor to be excised with an extra margin of safety.…”

“…Although bone invasion is thought to be a poor prognostic factor of tumor control by some, 8,10,11 other authors have varying opinions. 3,4,12 In our series, the local recurrence rate was 14.3% in the mandibular bone invasion group and 22.2% in the no mandibular bone invasion group.…”

Intraoperative Consultation (IOC) in Mucosal Lesions of the Upper Aerodigestive Tract

“…For oral cavity carcinomas, the presence of dentition significantly influences nerve-related spread. In evaluating spread of carcinoma within the mandible, McGregor and MacDonald [30,31] found a fourfold increase in cancer spread related to the inferior alveolar nerve in edentulous, nonirradiated mandibles as opposed to partially dentate, nonirradiated mandibles. Nerve involvement was associated with extensive spread of carcinoma in the medullary parts of the bone.…”

Mandi̇bular Medi̇al Li̇ngual, Lateral Li̇ngual Ve Bukkal Foramenleri̇n Ci̇nsi̇yete Bağli Sikliği

“…Although the accessory foramina are present more often on the medial side of the mandible 2,5,10 , they are also observed on its lateral one (buccal foramina) 2 . These foramina may be of significance in relation to the effectiveness of local anesthesia 3,6,7 , causing complications during dental procedures 1,3,6,8,9 , the metastasis of tumors 3,[11][12][13][14] . The aim of this study was to assess the frequency of mandibular accessory foramina (MMLF, MLLF and MBF) located on the both lingual and buccal side of mandible according to gender by DVT.…”