O'Brien C J, Carter R L, Soo K C, Barr L C, Hamlyn P J, Shaw H J
Head Neck Surg. 1986 Mar-Apr;8(4):247-56. doi: 10.1002/hed.2890080404.
The radiologic and histologic features of mandibular invasion, and its clinical implications, are considered in a retrospective series of 111 patients with squamous carcinomas of the oral cavity and oropharynx treated by composite resection. Eighty percent of the entire group had either recurrent or advanced (T3, T4) local disease, and 33 patients (30%) had histologic evidence of mandibular invasion by tumor. Preoperative radiologic assessment was unreliable in cases in which infiltrating tumor was confined to the periosteum and superficial cortex-44% false negatives. The extent of bone invasion was found to correlate with the size of the tumor, but not with its histologic grade. The mandibular periosteum was not seen as a morphologically discrete "barrier" and infiltration occurred at various points along the mandibular body, mainly related to the course of the inferior dental canal. The gross and microscopic patterns of bone invasion appeared to be similar in irradiated and nonirradiated resections. The incidence and pattern of recurrent disease following composite resection was the same in the groups with and without mandibular invasion: in each group half the patients were dead from disease and one third alive and free of disease at 2 years. Mandibular invasion alone did not appear to influence prognosis in this series.
在一项对111例接受联合切除术治疗的口腔和口咽鳞状细胞癌患者的回顾性研究中，对下颌骨侵犯的放射学和组织学特征及其临床意义进行了探讨。整个研究组中80%的患者患有复发性或晚期（T3、T4）局部疾病，33例患者（30%）有肿瘤侵犯下颌骨的组织学证据。术前放射学评估对于浸润性肿瘤局限于骨膜和浅表皮质的病例不可靠，假阴性率为44%。发现骨侵犯的程度与肿瘤大小相关，但与组织学分级无关。下颌骨骨膜在形态上并非一个离散的“屏障”，肿瘤沿着下颌骨体的不同部位浸润，主要与下颌管的走行有关。在接受放疗和未接受放疗的切除标本中，骨侵犯的大体和微观模式似乎相似。联合切除术后复发疾病的发生率和模式在有下颌骨侵犯和无下颌骨侵犯的组中相同：每组中一半的患者死于疾病，三分之一的患者在2年后存活且无疾病。在该系列研究中，单独的下颌骨侵犯似乎并未影响预后。
