Marginal mandibulectomy: Oncologic and nononcologic outcome

Christopher S Song, Gady Har-El
American Journal of Otolaryngology 2003, 24 (1): 61-3

BACKGROUND AND OBJECTIVES: Marginal mandibulectomy (MM) has been shown to provide an oncologically sound technique with preservation of function and cosmesis. We reviewed our experience with MM and analyzed oncologic and nononcologic complications.

PATIENTS AND METHODS: Retrospective review of patients, with clinical and/or radiological evidence of tumor attached to the mandible without cortical erosion, who underwent vertical, horizontal, or oblique marginal mandibulectomy. Data collection included demographics; tumor characteristics; clinical and radiologic relation to the mandible; surgical technique, with attention to neck dissection and facial artery ligation; radiation therapy; osteoradionecrosis (ORN); fractures; and recurrence.

RESULTS: Twenty-five patients underwent MM. Primary tumors included oral cavity (22), oropharynx (1). and metastatic neck tumor abutting the inferior/lateral border of the mandible (2). Two patients had local recurrence. Both had close soft tissue margins. Local control rate was 92%. Of 11 patients who had postoperative radiation to the primary site, 4 (36.4%) developed ORN, resulting in fractures in the mandibulectomy site in 2 of them. Two other patients developed early postoperative fractures: 1 patient had had previous radiation, and 1 patient had neck dissections with bilateral facial artery ligation and periosteal stripping. This poor technique led to necrosis of the remaining anterior mandible even before starting radiotherapy. Salvage segmental mandibulectomy was required in both patients.

CONCLUSIONS: MM provides an oncologically sound approach to tumors abutting the mandible. Careful attention to preservation of the remaining periosteum and facial arteries will prevent immediate postoperative complications. However, ORN is an important long-term complication that should be taken into account.

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