Patterns of invasion and routes of tumor entry into the mandible by oral squamous cell carcinoma
Patterns of invasion and routes of tumor entry into the mandible by oral squamous cell carcinoma
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DOI：
10.1002/hed.10062
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发表时间：
2002-04-01
影响因子：
2.9
通讯作者：
Woolgar, J
中科院分区：
文献类型：
--
作者：
Brown, JS;Lowe, D;Woolgar, J
背景：了解肿瘤侵犯下颌骨的方式、扩散和途径，对于口腔鳞状细胞癌下颌骨切除的适当水平和范围是至关重要的。我们对100例未经治疗的患者进行了一项前瞻性研究，探讨肿瘤侵袭的组织学模式和肿瘤进入下颌骨的途径。下颌骨肿瘤侵袭的模式取决于硬组织（p = 0.001）和软组织（p = 0.001）的侵袭深度。有证据表明，浸润的模式与疾病的组织学预后指标有关，如浸润淋巴结的囊外扩散（p = 0.03）。13例肿瘤均直接从下颌骨的基端进入，侵犯下颌骨的齿状部。55%（42例中的23例）的肿瘤侵犯无牙颌嵴，通过咬合（上级）表面进入。舌、口底和颊粘膜的肿瘤较牙槽或磨牙后部位的肿瘤更可能直接进入无牙颌嵴的下颌骨（p = 0.003）。软组织中更大或更深侵入的肿瘤更有可能侵入下颌骨，并显示出更具侵略性（侵入性）的肿瘤扩散形式，减少了更保守（边缘）切除的选择。肿瘤倾向于在基牙处进入下颌骨，在有牙颌和无牙颌中，基牙处通常位于反射和附着的粘膜的交界处。当计划下颌骨的边缘或边缘切除时，应假设肿瘤进入点在咬合嵴或牙龈嵴以下。(C)2002 Wiley Periodicals，Inc.
Background.An understanding of the patterns, spread, and routes of tumor invasion of the mandible is essential in deciding the appropriate level and extent of mandibular resection in oral squamous cell carcinoma.Methods. A prospective study of histologic patterns of tumor invasion and routes of tumor entry into the mandible was performed in a consecutive series of 100 previously untreated patients.Results. The pattern of tumor invasion of the mandible depended on the depth of invasion both in the hard (p =.001) and soft tissues (p =.001). There was evidence that the pattern of invasion was related to histologic prognostic indicators of the disease, such as extracapsular spread from invaded lymph nodes (p =.03). The route of tumor entry was at the point of abutment to the mandible (direct) in all 13 cases, invading the dentate part of the mandible. Fifty-five percent (23 of 42) of tumors invading the edentulous ridge entered through the occlusal (superior) surface. Direct entry to the mandible in the edentulous ridge was more likely for tumors arising in the tongue, floor of the mouth and the buccal mucosa compared with alveolar or retromolar sites (p =.003).Conclusions. Larger or more deeply invading tumors in the soft tissue are more likely to invade the mandible and show the more aggressive (invasive) form of tumor spread, reducing the options of a more conservative (rim) resection. Tumors tend to enter the mandible at the point of abutment, which in both the dentate and edentulous jaw is often at the junction of the reflected and attached mucosa. A point of tumor entry below the occlusal ridge or gingival crest should be assumed when planning rim or marginal resections of the mandible. (C) 2002 Wiley Periodicals, Inc.