Marginal Resection Of Mandible Research Articles

Influence of marginal and segmental bony resection on the local control of oral Squamous cell carcinoma involving the mandible

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

Treatment of breast deformity with free deep inferior epigastric perforator flap secondary to pectoralis major flap harvesting

Head and neck cancer is less common in women than in men. Free tissue transfer is the first choice in reconstructive option for head and neck tumor. Pedicle pectoralis major (PM) flap was a common option in head neck reconstruction in the past, but has become the salvage procedure when free flap fails. However, it is not suitable for female patients because of severe breast deformity and induced psychosocial distress. We present a female patient who had breast deformity due to PM flap reconstruction and was successfully treated with free deep inferior epigastric perforator (DIEP) flap. A 48-year-old woman had squamous cell carcinoma in the left side buccal mucosa, T2N0M0, stage II s/p wide excision with partial resection of maxilla and marginal resection of mandible. Free anterolateral thigh flap had been tried but in vain, then alternatively salvaged with a pedicle PM flap 3 years earlier. She presented with malposition of the left breast, nipple retraction, and high riding. We adequately released the contracture and reconstructed with a free DIEP flap. The free DIEP flap survived completely and restored a balanced breast with good shape and symmetry at 1-year follow-up. Although PM flap is a good modality in head and neck reconstruction, it should be used cautiously especially in female patients. The free DIEP flap is not only suitable for breast reconstruction in breast cancer patient, but also a good choice for a different purpose of breast reconstruction such as this patient with breast deformity due to PM flap harvest.

下顎大臼歯部に発生したエナメル上皮線維肉腫のｌ例

A case of ameloblastic fibrosarcoma in the molar region of the mandible of a 17-year-old girl is reported. Previously, the lesion had been diagnosed as benign ameloblastic fibroma on examination of a biopsy specimen. The final histological diagnosis after marginal resection of mandible was ameloblastic fibrosarcoma with ameloblastic fibroma. Therefore, another operation was performed. At present, the patient is well, and has had no problems as of 40 months since the last operation.

化骨性線維腫の２例

We have described two cases of ossifying fibroma in this paper.The first one was a recurrent case which occurred in a 52 year-old male patient. Tumor masses were found in the lower rim of mandible and in scar tissue close to previously operated areas. Histopthological examination revealed that tumor masses were composed of a proliferation of spherical and trabecular bones and dense fibrous tissue with a high cellularity.The second one was a case observed in a 26 year-old female patient. Histopathological examination revealed that the majority of tumors consisted of a proliferated fibrous tissue and a few immature fibrous bony tissues that were scattered at the peripheral region of this fibrous tissue.Although the enucleation of tumor or marginal resection of mandible were recommended for the treatment of ossifying fibroma, more extensive continuous resection of mandible should be applied to the cases which small tumor nests were scattered throughout the mandible such as case 1.