Mandibular invasion in oral squamous cell carcinoma

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Ash, Cecil Samuel
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Objective. To examine (1) the predictability of the orthopantomogram (OPG) in detecting mandibular bone invasion by oral squamous cell carcinoma (SCC), and (2) the independent effect of mandibular bone invasion on disease-free survival. Study design. A population based retrospective review of 107 patients with biopsy proven SCC of the floor of mouth, lower alveolus, and retromolar tr gone, who required mandibular resection as part of their treatment was undertaken. Each patient received an OPG which was compared with the histologic findings of bone invasion. Results. The OPG identified 62% of patients with bone invasion by oral SCC. The OPG's lack of sensitivity (positivity in disease) however, allows for a relatively high incidence of false negative interpretations. With the multivariate model, two variables, advanced clinical stage disease and deep bone invasion were found to be of prognostic relevance. Clinical stage of disease was determined to be a confounding variable of deep bone invasion, and after controlling for the effect of advanced clinical stage disease on disease-free survival, the independent effect of deep bone invasion failed to achieve statistical significance (p = 0.0845). Conclusion. The OPG is a useful initial assessment of mandibular bone invasion by oral SCC, however, it lacks the sensitivity to detect the early stages of bone invasion. In this study, mandibular bone invasion was not shown to be prognostically significant for disease-free survival. Therefore, further investigations are unnecessary to determine if focal invasion of the mandible is present. It is more important to achieve with a marginal or segmental mandibular resection a clear resection margin. (Abstract shortened by UMI.)