Posterior marginal mandibulectomy in the management of cancer of the oral cavity and oropharynx.
OBJECTIVE
To review a single institution's experience with posterior marginal (ramus) mandibulectomy for mandibular preservation in the management of patients with squamous cell carcinoma of the retromolar trigone or oropharynx. To review the history and surgical technique with emphasis on functional as well as oncologic outcomes.


METHODS
Retrospective review at a tertiary care academic referral center from 1996 to 2002.


RESULTS
Between 1996 and 2002, 382 patients with squamous cell carcinoma of the oral cavity and oropharynx were surgically treated at the Loyola University Medical Center. Medical records were reviewed and 152 patients were identified who had some form of mandibular procedure (segmental resection, marginal resection, or mandibulotomy) performed in conjunction with their tumor resection. Eighteen posterior marginal mandibulectomies were performed for primary cancers of the retromolar trigone, tonsillar fossa, and/or base of the tongue. All patients received adjuvant radiotherapy. Bone invasion of the marginal mandibulectomy specimens by squamous cell carcinoma was observed in 2 cases, neither of which developed a local recurrence. Mean and median overall survivals were 41.4 and 37.5 months, respectively. Functional outcomes were determined by administering the University of Washington Quality of Life instrument administered at 12 months. Patients reported significant alterations in chewing, but all were able to maintain satisfactory oral intake and no patient required a gastrosotomy tube.


CONCLUSIONS
A posterior osteotomy of the mandibular ramus is a useful adjunct in the surgical treatment of cancer of the retromolar trigone or oropharynx. Negative surgical margins can be obtained even with focal invasion of mandibular bone. The loss of bone in this area does not significantly affect patients' appearance. Patients report deterioration in chewing following this procedure but are able to maintain a diet of solid food.
Petruzzelli
Guy J
GJ
Department of Otolaryngology-Head and Neck Surgery, Division of Plastic and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL 60153, USA. gpetruz@lumc.edu
Knight
Fanchon K
FK
Vandevender
Darl
D
Clark
Joseph I
JI
Emami
Bahman
B
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000503:physiopathology / Q000601:surgery*; D008409:Mastication / Q000502:physiology; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods*; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome