Rim mandibulectomy for cancer of the oral cavity.

Improvements in our understanding of the methods of mandibular invasion by malignancies and refinements in the biomechanical analysis of mandibular osteotomies led us to modify our standard operative procedure for this disease process. Over a 10 year period, we performed rim mandibulectomy to treat oral cavity malignancies with mandibular involvement. This retrospective analysis of 38 patients comparing rim mandibulectomy with the traditional segmental mandibulectomy has demonstrated equivalent local control rates between rim mandibulectomy and segmental resection (75 and 64 percent, respectively). Patients with rim mandibulectomies were more satisfied with their postoperative appearance, and some were able to wear lower dentures if well motivated. In performing the rim mandibulectomy, we found that smooth, curved osteotomies without step-offs resulted in a technically simple operation that was biomechanically sound and had a low complication rate. Rim mandibulectomy, because it is based on sound pathologic principles and does not disrupt the mandibular arch, is an operation that adequately resects the tumor without compromising the cancer operation or the patient.