Zhang Shi-Long, Tian Jia-Wen, Jia Jun, Yu Zi-Li
Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, Hubei 430079, PR China; Dongfeng Stomatological Hospital, Hubei University of Medicine, Shiyan 442000, PR China.
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, Hubei 430079, PR China.
J Stomatol Oral Maxillofac Surg. 2025 Mar;126(2):102046. doi: 10.1016/j.jormas.2024.102046. Epub 2024 Sep 7.
Gingival squamous cell carcinoma (SCC) of the posterior mandible often requires marginal resection of the mandible in conventional surgery. However, the posterior location of the lesion can limit surgical visibility, which is critical for complete tumor removal and minimizing recurrence. Typically, marginal resection of the posterior mandible is achieved through a midline lower lip incision and mental nerve transection, providing adequate exposure but resulting in nerve damage, lip numbness, and facial scarring. In this paper, we describe a case using a submandibular incision for neck dissection, extending from the mandibular angle to the mental foramen, to fully expose the posterior mandible. The intraoral incision, extending 1 cm beyond the tumor margin, connected with the submandibular incision. Under direct vision, we performed a marginal resection of the mandible, preserving the inferior alveolar neurovascular bundle and the mental nerve, and maintaining at least 1 cm of the inferior mandibular margin. This technique achieved complete tumor removal while preserving mental nerve function and lower lip integrity, reducing surgical difficulty and patient trauma. This approach maintains nerve function and aesthetics as much as possible, with a faster postoperative recovery. In treating gingival SCC of the posterior mandible, it is essential to preserve surrounding healthy tissue and critical anatomical structures, minimizing postoperative complications while ensuring complete tumor resection.
下颌骨后部的牙龈鳞状细胞癌（SCC）在传统手术中通常需要进行下颌骨边缘切除术。然而，病变的后部位置会限制手术视野，而手术视野对于彻底切除肿瘤和减少复发至关重要。通常，下颌骨后部的边缘切除术是通过下唇中线切口和颏神经切断来实现的，这样能提供足够的暴露，但会导致神经损伤、唇部麻木和面部瘢痕形成。在本文中，我们描述了一例使用下颌下切口进行颈部清扫的病例，该切口从下颌角延伸至颏孔，以充分暴露下颌骨后部。口内切口在肿瘤边缘外延伸1 cm，并与下颌下切口相连。在直视下，我们进行了下颌骨边缘切除术，保留了下牙槽神经血管束和颏神经，并保留了至少1 cm的下颌下缘。该技术在保留颏神经功能和下唇完整性的同时实现了肿瘤的彻底切除，降低了手术难度和患者创伤。这种方法尽可能地维持了神经功能和美观，术后恢复更快。在治疗下颌骨后部牙龈SCC时，保留周围健康组织和关键解剖结构至关重要，在确保肿瘤完全切除的同时尽量减少术后并发症。
