Abstract
Oral cancers have a tendency to invade the surrounding bone structures, and this has a direct influence on the treatment management and on outcomes. The objective of this study was to correlate the clinical parameters (location, clinical presentation and TNM staging) of oral malignant tumors that can be associated with a potential of bone invasion and determine the accuracy of clinical examination to predict bone involvement, using computed tomography (CT). Twenty five patients, with oral malignant tumors were submitted to clinical and CT examinations. CT was considered the standard parameter to evaluate the presence of bone involvement. Clinical assessment of location, presentation form and TNM staging of the tumors were then compared to the CT findings in predicting bone involvement. Bone involvement was observed in 68% of the cases. It was predicted that tumors located in the retromolar trigone and hard palate, with a clinical aspect of infiltrative ulcer or nodule and classified in stage IV had a high potential to cause bone involvement. The clinical examination assessment of these tumors showed to be a valuable tool to predict bone invasion, with high sensitivity (82%) and specificity (87.5%), based on the results found in the CT images. No statistical significance was found between the CT and clinical examinations regarding bone involvement. The identification of some clinical parameters such as location, clinical presentation, and TNM stage, associated with a detailed clinical examination, was considered a valuable tool for the assessment of bone destruction by oral malignant tumors.
Highlights
Bone involvement was suspected in 15 cases (60%), whereas computed tomography (CT) detected the presence of bone involvement in 17 cases (68%)
Of the 15 cases with bone invasion detected by clinical examination, 1 was not confirmed by CT images, a false-positive case
Of the 10 cases with no evidence of bone invasion as detected by clinical examination, 3 had bone involvement confirmed by CT, a false-negative rate of 30% (Table 1)
Summary
Malignant tumors of the oral mucosa are mainly represented by squamous cell carcinoma, whose incidence in this site accounts for approximately 5% of all cases of this disease in the human body.[1,2] Oral malignancies are responsible for considerable morbidity and mortality; an accurate staging, which includes evaluation of bone involvement, is crucial for treatment planning and for improving survival rates.[2]These tumors have a tendency to invade the surrounding bone structures, and this occurs in 12% to 88% of the cases.[1,2,3,4,5,6,7,8,9,10] From a treatment perspective, it is crucial to determine the bone involvement caused by these tumors and, more importantly, the amplitude of bone involvement, since an underestimation may lead to a partial resection, resulting in local recurrence and potential metastasis.[2]. Malignant tumors of the oral mucosa are mainly represented by squamous cell carcinoma, whose incidence in this site accounts for approximately 5% of all cases of this disease in the human body.[1,2] Oral malignancies are responsible for considerable morbidity and mortality; an accurate staging, which includes evaluation of bone involvement, is crucial for treatment planning and for improving survival rates.[2]. Clinical evaluation, which mainly includes direct inspection and palpation, is a very important tool to assess the presence of bone involvement in oral malignacies.[4,13] On the other hand, several imaging modalities such as conventional radiography, ultrasonography, computed tomography, bone scanning and magnetic resonance imaging have been used to investigate the presence of bone involvement by oral cancers.[2,6,10,11,14] All these methods seem to have specific limitations; the use of computed tomography (CT) in the preoperative assessment of malignant tumors seems to be the most valuable technique, because it shows soft and bone tissues in the same exam and has a high sensitivity and specificity for the assessment of bone destruction.[1,6]
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