Review of segmental and marginal resection of the mandible in patients with oral cancer.

This paper reviews the medical literature of the last decade to ascertain the criteria used to assess mandibular invasion by cancer of the oral cavity and to suggest how best to evaluate the mandible with a view to surgical management. It is generally agreed that patients with mandibular invasion should be treated surgically, but the extent of mandibular resection required remains a controversial matter and the accurate preoperative determination of neoplastic invasion of the mandible remains a challenge for head and neck surgeons. The relative reliability of preoperative orthopantomography, (OPG) bone scanning, computed tomography (CT) and magnetic resonance imaging (MRI), and of peroperative periosteal stripping and direct inspection in clinical assessment for mandibular surgery, is discussed. The histological patterns of tumor invasion and the most common routes of tumor entry in the mandible are described and the influence of variables such as prior radiotherapy and an edentulous vs a dentate state in relation to perineural invasion are also discussed. Finally, a comparison is drawn between the reported outcome of marginal vs segmental resection procedures and a decision-making algorithm is proposed. In selected cases, marginal mandibulectomy can ensure satisfactory tumor control, with a favorable effect on the morbidity associated with mandibular surgery.