rtment of Otolaryngology-Head and Neck Surgery, Centre Hospitalier Régional De Lanaudiàre, St-Charles-Borromée, Québec, Canada.
J Otolaryngol Head Neck Surg. 2010 Feb;39(1):20-7.
To obtain completely negative margins of 1 to 5 mm at the time of surgery for oral tongue squamous cell carcinoma by using a Mohs-like technique.
Case series of 12 patients (4 T1, 5 T2, 2 T3, 1 T4) and a review of the literature.
For the first six cases, complete, colored for precise orientation, frozen margins of high quality were obtained in a relatively short time (20-75 minutes). Four levels were evaluated within 1 to 2 mm of the line of resection. Obtaining complete free margins for a thickness of 5 mm was done for the last six cases. The time was longer (70-120 minutes) but did not exceed the time necessary to perform the neck dissection, except for one patient. The technique using the scalpel and scissors implied slightly more bleeding, which was never a problem. We have observed no recurrence for these 12 patients (follow-up 12-34 months).
The review of the literature demonstrates that invaded and close margins confer a higher recurrence rate. We have obtained 1 to 2 mm (first six patients) and 5 mm (last six patients) thick, complete, oriented, and free frozen margins with success and no recurrence, but the follow-up was short. We prefer to obtain a 5 mm thick margin when possible. The delay to obtain the pathologic result is reasonable. This approach should reduce dramatically the problem of positive and close margins at the final pathology and, consequently, the rate of local control.
通过使用类似于 Mohs 的技术，在口腔舌鳞癌手术时获得 1 至 5 毫米的完全阴性切缘。
12 例患者（4 例 T1、5 例 T2、2 例 T3、1 例 T4）的病例系列和文献回顾。
在前 6 例中，在相对较短的时间内（20-75 分钟）获得了完整的、彩色的、用于精确定位的、高质量的冷冻切缘。在切除线内的 1 至 2 毫米处评估了 4 个水平。对于最后 6 例病例，获得了 5 毫米厚的完整游离切缘。时间较长（70-120 分钟），但除了 1 例患者外，并不超过行颈部解剖所需的时间。使用手术刀和剪刀的技术意味着稍微更多的出血，但从未成为问题。这 12 例患者（随访 12-34 个月）均未观察到复发。
文献回顾表明，侵犯性和接近性切缘会导致更高的复发率。我们已经成功获得了 1 至 2 毫米（前 6 例）和 5 毫米（后 6 例）厚的、完整的、定向的、游离的冷冻切缘，且无复发，但随访时间较短。当可能时，我们更倾向于获得 5 毫米厚的切缘。获得病理结果的延迟是合理的。这种方法应大大减少最终病理学中阳性和接近性切缘的问题，从而降低局部控制率。
