Treatment of Mandibular Gingival Cancer with Bone Invasion Where Clear Resection Margins Are Obtainable

Clinical Scenario

This protocol addresses gingival cancer arising on the mandibular gingiva that has invaded bone but has not deeply penetrated the cancellous bone, and where a clear surgical resection margin can be obtained.

Surgical Approach

The recommended intervention is a bone-preserving resection of the mandible — specifically a type that maintains the inferior border of the mandible — with the requirement that an adequate margin of uninvolved bone is secured around the tumour. The precise margin requirement and technical criteria are set out in the full protocol.

Treatment Goal

The primary objective is a negative bone resection margin, confirmed by removal of a defined amount of unaffected bone surrounding the tumour.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.21053/ceo.2018.01816

(A) Marginal mandibulectomy is recommended if the cancer has not deeply invaded into the cancellous bone, and if a resection margin is obtainable.
(B) Maintenance of a bone margin of at least 10 mm is necessary in mandibulectomy (weak recommendation, low quality evidence).
McGregor and MacDonald [134] recommended a resection of 5 to 10 mm of uninvolved bone around the tumor, and other researchers have suggested removal of at least 10 mm of unaffected bone in the case of macroscopic tumors with suspected bone involvement.

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