Impact of mandibular condyle preservation on patterns of failure in head and neck cancer.
OBJECTIVE
To determine the role of native condyle preservation in local recurrence after segmental mandibulectomy in patients with head and neck squamous cell carcinoma.


METHODS
Retrospective chart review with main outcome measuring local control of cancer.


RESULTS
Between 1994 and 2003, 72 patients (48 men, 24 women) with an average age of 73.5 years without previous treatment underwent segmental mandibulectomy. Fifty-four cases (n = 54) involved the mandible posterior to the mental foramen and are the subject of this review. In 36 patients, the condyle was preserved and mandibular continuity was restored. In 18 patients, condyle and ramus were resected without mandibular reconstruction. Reconstructive modalities included primary closure (3), split-thickness skin graft (3), pedicle flap (19), and free tissue reconstructions (29). Overall local-regional recurrence rate was 22 percent (12 of 54); no recurrences were identified in patients who underwent condylar resection. Recurrences were observed in patients with mandibular reconstruction by both plate and pedicle flap (5 of 9) or (osteo) myocutaneous free flap (7 of 27).


CONCLUSIONS
Condylar preservation may predispose patients to local recurrence after segmental mandibulectomy. This does not translate into overall reduction in survival.
Petruzzelli
Guy J
GJ
Department of Otolaryngology, RUSH University Medical Center, Chicago, IL, USA. gpetruz@lumc.edu
Cunningham
Kelly
K
Vandevender
Darl
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008335:Mandibular Condyle; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019647:Oral Surgical Procedures / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome