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口腔癌的下颌骨边缘切除术——分类与适应证

Marginal Mandibulectomy in Oral Cavity Cancers - Classification and Indications.

作者信息

Nair Sudhir, Singhavi Hitesh R, Mestry Vidula, Shetty Rathan, Joshi Poonam, Chaturvedi Pankaj

机构信息

Head and Neck Surgery, Department of Surgical Oncology, ACTREC, Homi Bhabha National Institute, Tata Memorial Centre, Navi Mumbai, India.

Head and Neck Surgery, Department of Surgical Oncology, Fortis Hospital Mulund, Mumbai, India.

出版信息

Indian J Surg Oncol. 2025 Apr;16(2):581-586. doi: 10.1007/s13193-024-02102-w. Epub 2024 Oct 11.

Abstract

Squamous cell carcinoma of the lip and oral cavity (OSCC) is a significant global health issue, particularly in low-income countries, with an estimated 390,000 cases detected annually. Although surgery remains the primary treatment option, complex resections are frequently required to attain clear margins. Traditionally, a part of the jaw bone close to the tumour is resected (segmental mandibulectomy) during the surgery. However, marginal mandibulectomy (MM), involving the resection of the mandibular rim while preserving its continuity, offers a less debilitating alternative to segmental mandibulectomy (SM) in selected cases. This review examines marginal mandibulectomy's oncological safety and efficacy and its current role in managing oral cavity cancers, as indicated by the most recent literature. MM is an effective treatment for tumours, which abut the mandible without bone invasion and provides comparable oncological outcomes to SM, with fewer functional and cosmetic deficits. The authors also propose a classification based on the plane of resection and location within the mandible. We believe this classification will be helpful in reporting the MM series done in various centres in a uniform fashion. However, there is a need for precise surgical planning before doing an MM for obtaining the optimal results.

摘要

唇和口腔鳞状细胞癌(OSCC)是一个重大的全球健康问题,在低收入国家尤为突出,估计每年有39万例病例被发现。尽管手术仍然是主要的治疗选择,但通常需要进行复杂的切除以获得切缘阴性。传统上,手术过程中会切除靠近肿瘤的部分颌骨(节段性下颌骨切除术)。然而,边缘性下颌骨切除术(MM),即在保留下颌骨连续性的同时切除下颌骨边缘,在某些情况下为节段性下颌骨切除术(SM)提供了一种创伤较小的替代方案。本综述根据最新文献,探讨了边缘性下颌骨切除术的肿瘤学安全性和有效性及其在口腔癌治疗中的当前作用。MM是治疗紧邻下颌骨且无骨质侵犯肿瘤的有效方法,与SM相比,其肿瘤学结局相当,但功能和美容缺陷较少。作者还根据切除平面和下颌骨内的位置提出了一种分类方法。我们认为这种分类将有助于以统一的方式报告在各个中心进行的MM病例系列。然而,在进行MM之前需要进行精确的手术规划以获得最佳效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b848/12052715/810e87938497/13193_2024_2102_Fig1_HTML.jpg

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