Horizontal versus vertical block resection for early floor of mouth carcinoma

Although the literature affirms the superiority of block resection over local excision for the surgical treatment of early squamous cell carcinoma of the anterior floor of the mouth, the best method of block resection is not certain. Two methods are in widespread use; a horizontal procedure (HB) and a vertical procedure (VB). This retrospective study compares these two procedures according to outcome in separate series of patients treated between 1970 and 1984. Patients were followed for a minimum of 3 years with an average follow-up of 6 years. Twenty-five patients underwent HB while 27 underwent VB. Control at the primary site was 100% for HB and 74% for VB. Neck metastasis and distant metastasis occurred with equal frequency. Determinate survivals at 3 and 5 years were 96% and 91% for the HB group and 93% and 65% for the VB group. Local recurrence correlated with tumor growth posteriorally toward the ventrum of the tongue, suggesting an explanation for the difference in outcome between the two procedures. We conclude that the HB procedure is the preferable surgical procedure for stage I and II disease.