Treatment of Gingival Cancer of the Mandibular Gingiva with Extensive Medullary Bone Invasion
This protocol covers gingival cancer arising from the mandibular gingiva in three anatomically distinct situations: extensive medullary bone invasion, a previously irradiated mandible, and an edentulous thin mandible. Each of these features significantly influences the surgical strategy required for oncological control.
Clinical Scenario
Extensive medullary bone invasion represents the primary driver of this protocol. Cases involving a previously irradiated mandible or an edentulous, structurally thin mandible are also addressed, as both alter the oncological and reconstructive calculus. The specific combination of factors present in each patient informs the scope of surgical intervention.
Surgical Approach
Management centres on a mandibular resection strategy designed to achieve clear soft-tissue margins in the context of deep bony involvement. The extent of the resection is determined by the anatomical distribution of disease, with particular attention to specific nerve canal structures within the mandible. The complete decision algorithm — including which anatomical boundaries govern the extent of resection — is contained in the full protocol.
Clinical Goal
The primary oncological objective is achieving negative soft-tissue safety margins.
References
DOI: 10.21053/ceo.2018.01816
- Segmental mandibulectomy should be performed for patients with extensive bone invasion (strong recommendation, high-quality evidence).
- (B) Segmental mandibulectomy can be considered for those with an irradiated or edentulous thin mandible (weak recommendation, low-quality evidence).
- If the inferior alveolar nerve canal is involved, a segmental mandibulectomy beyond the mandibular and mental foramen is needed.
- However, a segmental mandibulectomy is required to obtain the oncological safety margins of soft tissue in patients with extensive medullary invasion.
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