Mandibular preservation in oral cancers by Dr. Asheed Hakeem

Contemporary management of the oral cancer is primarily focused on preservation of the continuity of the mandible, because it serves sev...


Contemporary management of the oral cancer is primarily focused on preservation of the continuity of the mandible, because it serves several important roles in function, esthetic and psychological aspects of the face.

The desired result is achieved either by preserving continuity or by reconstruction of the arch, if it is necessary to sacrifice a segment of the bone for oncologic clearance. Of these two alternatives, preservation of the arch has the advantage of simplicity, and therefore would be preferable if it is compatible with effective tumor excision i.e. oncologically safe.

The ideal cancer operation for oral cancers, the so-called composite resection, was introduced by Crile in 1906, based on the concept of the lymphatic drainage of the buccal mucosa as described by Polya and von Navratil in 1902. In their anatomic studies they conceptualized that lymphatics from the buccal mucosa passed to the neck nodes through lymphatic channels in the mandibular periosteum.

This laid the foundation of the  radical surgery which  removed the cervical lymph node-bearing regions (neck dissection) and intervening lymphatic channels (mandibulectomy) in continuity with the oral primary, irrespective whether the mandible was infiltrated by the cancer or not.

However, these extensive surgeries were marred by very high perioperative mortality and significant functional morbidity without enhancing the cure rates. Remarkable developments in anesthesia, instrumentation, antibiotics and perioperative nutrition management made these advanced surgical techniques possible and thus the advent of the modern composite operation (Figure 1 and 2).

Modlin and Johnson (1955) stressed on the sacrifice of a portion of the mandible even when the mandible was not involved, they emphasized that the segment of mandible should be removed without hesitation and without considering function or esthetic aspects.


The remarkable studies by Marchetta and Sako (1966), Marchetta et al (1971) and Carter et al (1983) demonstrated that periosteal invasion does not occur without actual tumor-bone abutment. They determined that   infiltration of the mandible occurred by direct invasion rather than by lymphatic spread. These landmark publications laid the foundation of the mandibular preservation surgeries without compromising local tumor control. These studies were supplemented by histologic studies by O’Brien et al (1986) and McGregor and MacDonald (1987-1989).

As a result of these studies, a variety of conservative mandibulectomy techniques are being increasingly used now a day. Marginal mandibulectomy is now an accepted technique for mandibular preservation without compromise of the oncologic safety. It is indicated for the lesions abutting or early invasion of the mandible i.e less than 5mm (Figure 3 and 4).

Not only should adequate bone height be preserves but care should be taken not to injure vascular supply of inferior neurovascular bundle. This will prevent avascular necrosis and iatrogenic fractures. In case radiotherapy is also given in such a situation, there is very high likely hood of developing osteoradionecrosis (Figure 5).

Care should be taken to make the ends curved and smooth with minimal separation of the bone from the periosteum.Height of mandible preserved should not be less than 10 mm (figure 6).If a situation arises where the mandibular height preserved is less than 10mm, one should not hesitate in either doing prophylactic mini plate fixation or converting it into a proper segmental mandibulaectomy.

It should always be kept in mind that it is better to perform good segmental mandibulectomy rather than an ill performed marginal mandibulecty. Despite recent advances in reconstruction techniques, the functional and cosmetic ramifications are still significant, so more conservative surgical extirpation in respect to mandibular preservation can have significant functional and cosmetic implication for the oral cancer patients. However, failure to remove the mandible when carcinoma has invaded it allows progression of disease. Determination of the extent of mandibular invasion by oral cancer is crucial for treatment planning.

Treatment failures of oral squamous cell carcinoma usually results from local recurrence. Clinical examination and radiographic studies to determine the extent of mandibular resection required are not usually precise. If it is difficult to  predict extent of mandibular involvement, the oncologic surgeon needs an intraoperative assessment for  predicting adequate resection.


Dr. Arsheed Hakeem is a senior consultant at the department of head and neck Oncology, Apollo cancer hospitals. Hyderabad. India. He is a member of the seasoned team of specialists that made Apollo hospital the most preferred by patients all across the globe. He can be reached via Apollo hospital website.

COMMENTS

Name

Aaron Ramsey,2,Ac Milan,24,Adam Llana,1,Adnan Januzaj,3,Aguero,2,Alex Iwobi,1,Alexis Sanchez,3,Alvaro Morata,2,Ander Herrera,1,andre ayew,1,Andre schurrle,2,Andrea Pirlo,3,Andrey Arshavin,1,Angel Di Maria,2,anthony martial,2,antonio conte,1,arda turan,4,Argentina,13,Arjen Robben,2,Arsenal,247,Arsene Wenger,19,arturo vidal,2,AS Roma,5,Asamoah Gyan,2,Aston Villa,6,Atletico Madird,1,Atletico Madrid,17,Aubameyang,2,Bacary Sagna,1,Bale,2,Ballon d'or,4,Balotelli,3,Barcelona,90,Bastian Schweinsteiger,2,Bayer Leverkusen,1,Bayern munich,36,begovic,1,belgium,7,Benfica,2,benteke,1,Benzema,8,Bertrand Traore,1,betting,160,betting tips,1,Birmingham,1,blog post,27,blog spot,1,blogpost,5,blow,1,Borrusia Dortmund,1,Borussia Dortmund,11,Bournemouth,2,Brazil,21,Brazil 2014,6,brazil match highlights,1,Brazuca,1,Breaking news,1,Brendan Rodgers,1,Brighton,1,Bundesliga,12,Burkina faso,1,Burnley,1,cameroon,7,Capital one cup,15,Carabao cup,1,cardiff,4,Cardiff city,2,Carlos Marchena,1,Carlos Tevez,2,Carlton Cole,1,Cazorla,1,CECH,3,Celta vigo,2,Cesar Azpilicueta,2,Cesc Fabregas,1,Champions League,10,CHAN,1,Charly Musonda,1,chelsea,307,Cheslea,3,Chile,1,Christian Benteke,2,colombia,3,conte,1,Copa America,2,Copa Lagos 2013,1,Costa Rica,1,Coutinho,2,Cristiano Ronaldo,69,croatia,4,Crystal Palace,2,Crystal Palce,1,Dani Alves,2,Daniel Sturridge,1,Danny Welbeck,1,David Beckham,3,David de gea,3,David Luiz,5,David Moyes,1,David Silva,3,Demba Ba,2,Di Maria,5,dider drogba,1,Didier Drogba,3,Diego Costa,10,Dortmund,1,Douglas Costa,2,drake,1,Dzeko,1,Eboue,1,eden hazard,11,edgar davids,1,Edin Dzeko,1,Egypt,1,El Classico,7,El Shaarawy,1,elche,1,Elderson Echiejile,1,Emmanuel Emenike,1,emre can,1,england,36,English premier league,62,Enyimba FC,2,EPL,193,Eric de Oliveira,1,Erik Lamela,1,Ethiopia,1,Eto'o,2,Europa League,1,Europe,8,Everton,11,FA Cup,12,FA Cup final,1,Fabio,1,Fabio Borini,1,Fabregas,1,Falcao,9,fans,1,feature dpost,1,featured,466,Featured news,1,Featured post,700,featured postSource: Alex Livesey/Getty Images Europe,1,fernado llorente,1,fernandinho,1,Fernando Torres,3,Fetaured,1,fifa 16,4,FIFA Ballon d'or,1,fifth round draw,1,Fiorentina,2,football wags,1,footballer's girlfriend,1,france,8,Franck Ribery,3,Frank Lampard,2,French Ligue 1,5,Fulham,4,Fulham Liverpool,1,gabriel Jesus,1,Gareth Bale,4,Gary Neville,1,German Bundesliga,8,Germany,13,Gervinho,1,getafe,1,Ghana,3,gibbs,1,gif,123,Giorgio Chiellini,1,Giroud,2,goal,66,Goals,2,Golazo,73,gold cup,1,Golden eaglets,2,Gonzalo Higuain,1,Gossip,91,graphic,4,guedes,1,Guiseppe Rossi,1,Halloween,1,Hamburger,1,Harry Kane,8,hazard,3,Hernanes,1,Hertha Berlin,1,history,1,Holland,7,huddersfield,1,Hulk,1,Hull city,3,Ibrahimovic,1,iceland,2,iheanacho,1,IK Uche,2,Iker Casillas,2,Individual Highlights,20,Iniesta,3,inler,1,Inter,1,Inter Milan,7,International friendly,1,Interview,17,Isco,1,Italian Serie A,8,Italy,9,ivica Olic,1,Ivory coast,2,Iwobi,1,Jack Wilshere,1,James Rodriguez,1,Japan,1,Javi Martinez,1,Javier Hernandez,1,Jesus navas,1,Joe Hart,1,Joel Campbell,1,John Obi Mikel,2,John Terry,1,Johnny Evans,1,Jordan,1,jordon ibe,1,jose callejon,1,Jose Mourinho,54,Juan Mata,19,Juventus,32,Kagawa,2,Kaka,2,Kante,1,Karim Benzema,3,Kelechi Iheanacho,7,Kenneth Omeruo,3,Kenya,1,Kevin De Bruyne,7,Klopp,1,koke,1,kolarov,1,Kyle walker,1,LA Galaxy,1,La liga,45,Lates news,2,latest,2,latest news,7,latest news,1614,latest news news,1,latest news world cup,1,latest news. video,2,latest post,1,Laurent Koscielny,1,Lavezzi,1,Leandro Bacuna,1,leicester,4,Lewandoski,2,Ligue 1,6,lille,1,Lionel Messi,20,Lionel Messi. Argentina,1,Live stream,73,liverpool,118,Loic Remy,2,louis van gaal,4,Lucas Moura,1,Luis suarez,19,Luka Modric,1,Lukaku,2,Lyon,2,Man city,11,Man utd,1,Mancheste City,1,manchester city,103,manchester united,209,Manchetser city,1,manchetser united,1,Mandela,1,Maradona,3,Marco Reus,3,Mario Balotelli,12,Mario Gotze,1,Marseille,2,match,1,Match fixing,1,Match highlights,275,match highlights manchester city,1,match higlights,1,Match Preview,1,match report,5,matci,1,Maurizio Sarri,4,Mbappe,4,Memphis Depay,3,Mertesacker,1,mess,1,Messi,40,mesut ozil,9,Mexico,13,Michael Carrick,1,Michel Platini,1,mikel,1,Mikel Arteta,1,Mikel Obi,1,miranda,1,MLS,7,Monaco,3,Mourinho,3,mum,1,Nadal,1,Nani,3,Napoli,9,nathan,1,neews,1,new,3,New Zealand,1,newcastel,1,Newcastle,20,Newcastle united,4,news,1530,news latest news,1,news manchester united,1,news Obi Mikel,1,news. opinion,1,news. video,1,newst chelsea,1,Neymar,21,Nigeria,258,Nigeria premier League,1,Norwich,6,Novak Djokovic,1,NPFL,5,Obi Mikel,1,ochoa,1,odion ighalo,3,olic,1,Oliver Giroud,3,Olivier Giroud,2,Olly Murs,1,Olympique Marseille,2,Opinion,206,oscar,3,Ozil,6,Pandurii,1,Paul Pogba,8,Pedro,9,Pemier League,1,Pep Guardiola,7,Per Mertesacker,1,peru,1,Petr Cech,8,Phillipe Coutinho,1,Picture,172,picture. Arsenal,1,Pictures,17,pictures news,1,pictures real madrid,1,Pierre-Emerick Aubameyang,1,Piers Morgan,1,pinto,1,pique,1,Pirlo,1,Player and Manager of the month,1,Pochettino,1,Pogba,1,POLAND,1,porto,1,portugal,6,post-match interview,2,predictions,1,Premier League,331,Preview,2,PSG,25,Pulisic,1,Qatar,1,Rafael Nada,1,raheem sterling,4,Ramires,2,Real Betis,1,Real Madrid,91,real marid,1,Real Sociedad,3,reece oxford,1,Rio Ferdinand,2,Robert Lewandoski,4,Robert Snodgrass,1,Robin Van persie,7,Robinho,1,Roma,4,Romelu Lukaku,5,Ronaldinho,2,Ronaldo,1,Rooney,3,rumour,9,Ryan giggs,1,Sadio Mane,2,salah,3,Sam Sodje,1,Sami Khedira,1,sampdoria,1,Samsung,1,Samuel Eto'o,2,Santi Cazorla,1,sarri,1,scary,1,Schalke,8,Scotland,2,senegal,3,Sepp Blatter,1,sergio aguero,4,Sergio Ramos,1,Serie A,23,Sevilla,3,Sky sports,1,Song,1,Southampton,13,Spain,34,Spanis La liga,2,Spanish La Liga,10,Starting XI,2,Steven Gerrard,2,Stoke,3,Stoke city,5,Suarez,1,suicide bomber,1,sunday oliseh,2,Sunderland,6,super eagles,7,Swansea,6,SWEDEN,1,Taiye Taiwo,1,Team news,43,team news. Liverpool,1,team of the week,2,terrorist,1,the fa cup,3,thibaut courtois,1,Thiery Henry,4,toni kroos,1,tor,1,Tottenham,21,Tottenham hotspur,30,Transfer,264,Transfer news,118,transfer news latest news,1,Transfer rumour,2,transfers news,1,trasnfer,1,Tunisia,1,U-17 World cup,5,uchebo,1,UCL,27,UEFA,1,UEFA Champions League,30,UEFA EUROPA LEAGUE,2,Unai Emery,1,Uruguay,3,USA,3,Valencia,2,van gaal,1,Van persie,2,Victor Moses,7,Vidal,1,Video,741,Video falcao,1,video match highlights,1,video world cup,1,video. barcelona. neymar,1,video. goal,1,videos,5,Vieo,1,Villareal,4,Vincent Enyeama,3,viswo,1,WAG,1,WAGS,3,Watford,8,Wayen Rooney,1,Wayne Rooney,7,Welbeck,1,Werder Bremen,2,West brom,5,West Ham,9,Willian,5,Wolfsburg,4,Wolves,2,women,1,World cup,363,World cup qualifier,1,Xabi Alonso,1,Yaya Toure,7,Yoan Gouffran,1,Yohan Cabaye,2,Zambia,1,Zidane,2,Zlatan Ibrahimovic,4,
ltr
item
Footballnus | Get the latest football news, highlights, videos, and transfer gossip: Mandibular preservation in oral cancers by Dr. Asheed Hakeem
Mandibular preservation in oral cancers by Dr. Asheed Hakeem
http://1.bp.blogspot.com/-aDC2w-icMvA/VfiRbf0xIiI/AAAAAAAAGiQ/jrIxTIRs5ss/s640/Mandible%2B4.jpg
http://1.bp.blogspot.com/-aDC2w-icMvA/VfiRbf0xIiI/AAAAAAAAGiQ/jrIxTIRs5ss/s72-c/Mandible%2B4.jpg
Footballnus | Get the latest football news, highlights, videos, and transfer gossip
https://www.footballnus.com/2015/09/mandibular-preservation-in-oral-cancers.html
https://www.footballnus.com/
https://www.footballnus.com/
https://www.footballnus.com/2015/09/mandibular-preservation-in-oral-cancers.html
true
138668994082972833
UTF-8
Loaded All Posts Not found any posts VIEW ALL Readmore Reply Cancel reply Delete By Home PAGES POSTS View All RECOMMENDED FOR YOU LABEL ARCHIVE SEARCH ALL POSTS Not found any post match with your request Back Home Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sun Mon Tue Wed Thu Fri Sat January February March April May June July August September October November December Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec just now 1 minute ago $$1$$ minutes ago 1 hour ago $$1$$ hours ago Yesterday $$1$$ days ago $$1$$ weeks ago more than 5 weeks ago Followers Follow THIS PREMIUM CONTENT IS LOCKED STEP 1: Share to a social network STEP 2: Click the link on your social network Copy All Code Select All Code All codes were copied to your clipboard Can not copy the codes / texts, please press [CTRL]+[C] (or CMD+C with Mac) to copy Table of Content