Tei Kanchu, Totsuka Yasunori, Iizuka Tadashi, Ohmori Keiichi
Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan.
J Oral Maxillofac Surg. 2004 Jul;62(7):834-9. doi: 10.1016/j.joms.2003.09.014.
The study goal was to investigate the adequacy of marginal resection of the mandibular bone in cases of squamous cell carcinomas of the lower alveolus and gingiva where the radiologically detected bone defect does not extend beyond the mandibular canal.
Sixty-two patients who have had a mandibulectomy performed with or without preoperative radiotherapy and chemotherapy were the study subjects. This retrospective study investigated the correlation between the preoperative radiographic appearance and histopathologic findings of the excised tissue. The results of the treatments were evaluated.
In the cases with erosive bone defects, the extent of the bone involvement did not exceed the extent of the radiographically detected bone defects. However, in 7 (36.8%) of the cases with moth-eaten type bone defects, the extent of bone involvement exceeded the bone defects detected by radiography. Further, 10 of the 16 cases with no apparent bone defect showed apparent bone involvement by the tumors histologically. There were no differences in the 5-year cumulative survival rate between the marginal resection and segmental groups.
Marginal resection was effective in controlling mandibular alveolus and gingival cancers when radiologically detected erosive bone defects did not extend beyond the mandibular canal. Marginal resection was inadequate when moth-eaten defects were radiologically detected, except when the bone defects were confined to the alveolar bone.
本研究的目标是调查在下颌骨牙槽和牙龈鳞状细胞癌病例中，当放射学检测到的骨缺损未超出下颌管时，下颌骨边缘切除的充分性。
62例行下颌骨切除术的患者为研究对象，这些患者接受或未接受术前放疗和化疗。本回顾性研究调查了术前影像学表现与切除组织病理结果之间的相关性，并评估了治疗结果。
在有侵蚀性骨缺损的病例中，骨受累范围未超过放射学检测到的骨缺损范围。然而，在7例（36.8%）有虫蚀样骨缺损的病例中，骨受累范围超过了放射学检测到的骨缺损范围。此外，16例无明显骨缺损的病例中有10例在组织学上显示肿瘤有明显的骨受累。边缘切除组和节段切除组的5年累积生存率无差异。
当放射学检测到的侵蚀性骨缺损未超出下颌管时，边缘切除对控制下颌牙槽和牙龈癌有效。当放射学检测到虫蚀样缺损时，边缘切除是不充分的，除非骨缺损局限于牙槽骨。
