Marginal mandibulectomy: 11 years of institutional experience

Literature on marginal mandibulectomy deals mainly with floor of mouth cancers. The purpose of the present study was to evaluate the oncologic outcome of marginal mandibulectomy in buccal sulcus cancer as compared with floor of mouth cancer.

Chart review of 179 patients who underwent marginal mandibulectomy during 1993 to 2003 at Tata Memorial Hospital yielded 161 marginal mandibulectomies done for squamous cell carcinoma (SCC). Oncologic outcomes in terms of disease control and cause-specific survival for the gingival buccal and tongue/floor of mouth cancers were compared. Independent impact of various prognostic factors on the local control and cause-specific survival was evaluated using Cox proportional hazards model.

A total of 137 marginal mandibulectomies were done for SCC in gingival buccal complex and 24 for floor of mouth SCC. Bone was microscopically involved in 13 (8.1%) cases and mucosal margin of excision showed tumor in 12 (7.5%) cases. However, they had no influence on locoregional failure or cause-specific survival. Cause-specific survival at 2 and 5 years was 85.6% and 72.2%, respectively. Cause-specific survival at 5 years was significantly better for buccal cancer than floor of mouth cancer (P = .041). On multivariate analysis patients with floor of mouth cancer were at a 3 times higher risk of dying of disease than those with buccal cancer.

In carefully selected patients, marginal mandibulectomy in buccal sulcus cancer achieves at least as good local control and survival as compared with the floor of mouth cancer.