Abstract
Background and objective: Marginal or segmental resection of bone are often required for tumor removal in oral squamous cell carcinoma patients to secure adequate margin. The present study aims to evaluate the surgical outcome and post-operative complication of both group of patients and also assesses the local control of the disease in the oral cavity.
 Methods: In this prospective study, 32 patients who were treated with marginal or segmental jaw resection for oral squamous cell carcinoma of the lower part of oral cavity was undertaken within September 2008 to August 2013.There were 9 males and 23 females with a median age of 40.5 years. Twenty patients underwent marginal and 12 patients had segmental resection of the mandible. Distribution of the subject by age, sex, primary site of lesion, pathologic tumor stage, presence of mandibular invasion, pathologic cervical lymph node stage and feature of post- operative complications were analyzed prospectively.
 Results: According to this study, the mandible was involved in 83.3% of patient with segmental resection and 15% of patients with marginal resection. Buccal mucosa was mostly involved site in marginal group (60%) and retro molar trigon was highly involved site with segmental group (41.7%). In marginal group 30% cases was involved with stage1 and 70% was stage2; in segmental group 25% cases were stage2 and 67.7% were stage3. Statistically significant difference was exist in pathological cervical node stage(p<0.05). Mandibular invasion was significantly more in segmental group (p<0.05). Soft tissue surgical margins were positive in 4 patients (20%) in the marginal group and in 3 patients (25%) in the segmental group. Negative neck lymph node was found in 20 (63%) cases and positive neck node was found in 12 (37%) cases, of which four patients, including 2(15%) cases in the marginal group and 2(8.3%) cases in the segmental group was died. Trismus and mastication problems were found higher in segmental than marginal resection group.
 Conclusion: Marginal resection of mandible is effective for patient with oral squamous cell carcinoma in the early stage. Post-operative outcome and local control of disease in segmental group were slightly higher than marginal group. Positive surgical margin status and bone invasion was found as the most important predictor of local control of the diseases in patient with oral squamous cell carcinoma.
 Bangladesh Journal of Medical Science Vol.18(4) 2019 p.801-807
Highlights
Squamous cell carcinoma is the most common (90% of all) cancer in the oral cavity
Segmental resection is indicated in case of cancer with gross mandibular invasion but marginal resection usually done in the absence of medullary invasion[4].In cases where cancer does not erode the bone even though it may be in close proximity to the mandible, or where there is no indication of bone destruction, marginal resection is as effective as segmental resection.[5, 6]
According to the study of Robert A.ORD et al14, most tumors occurred in the floor of the mouth were treated by marginal resection, where as in the segmental resection group the retromolar trigon was the most common site
Summary
Squamous cell carcinoma is the most common (90% of all) cancer in the oral cavity. In Bangladesh, Oral cancer accounts for 20% of whole body malignancy. [ 1]Beside these, only 10-15% of the oral cancers in Bangladesh are detected at an early stage and more than 83.4% of oral cancers at the time of diagnosis are found extensive and in late stage of malignancies. [2]The therapeutic goals in the management of cancers in the oral cavity are eradication of the tumor, prevention of recurrence and achievement of an acceptable cosmetic appearance without compromising oncologic management. The aim of this study was to evaluate the effectiveness of both types of resection with regard to the local control of the diseases and to assess post- operative complications after surgical treatment of oral squamous cell carcinoma involving the mandible in different stages. All patients with oral squamous cell carcinoma involving mandible recruited for this study were selected on the basis of the following variables : age, sex, primary site of tumor, pre-operative staging result, pathological cervical node stage, pathological tumor stage, radiological findings of bone invasion, histopathological pattern of invasion: e.g. lymphvascular invasion, perineural invasion and depth of bone invasion reported by the histopathologist; histopathological status of surgical margin of soft tissue, post-operative complication and result of follow-up etc. Soft tissue surgical margin was positive in 7 patients (21.9%), including 4 cases in the marginal group (20%) and 3 in the segmental group (25%) This difference was not statistically significant (p>0.05).
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