Predictors of Mandibular Involvement in Cancers of the Oromandibular Region
Predictors of Mandibular Involvement in Cancers of the Oromandibular Region
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DOI：
10.1016/j.joms.2008.06.059
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发表时间：
2009-05-01
影响因子：
1.9
通讯作者：
Das, Shaima R.
中科院分区：
文献类型：
--
作者：
Pandey, Manoj;Rao, Latha P.;Das, Shaima R.
目的：口腔鳞癌侵犯下颌骨不仅是保留下颌骨的相对禁忌症，也是预后不良的指标。本研究着眼于可能有助于预测下颌骨受累的临床、放射学和手术变量。患者和方法：进行了一项前瞻性研究，以评估 51 例位于下颌区域的口腔鳞癌的下颌受累及其预测因素。所有患者均接受了部分下颌骨切除术或半下颌骨切除术。详细的临床检查之后是放射学评估和手术评估。通过chi(2)检验进行统计分析（比值比[OR]，显着性水平为5%）。通过逻辑回归分析进行多变量分析。结果：单变量分析确定肿瘤位于下牙槽（OR = 8.5），下牙槽神经感觉障碍（OR = 16.2），肿瘤位置在下颌骨1 cm以内（OR = 1.4），存在骨膜条纹（OR = 2.0），如骨膜下反应（OR = 3.5），皮质扩张 （OR = 8.8）和存在病理性骨折（OR = 2.3）作为骨侵袭的预测因子。多变量分析发现，肿瘤分级 (P = .05) 和放射学骨受累 (P = .02) 是病理性骨受累的显着独立预测因子。 结论：通过结合临床检查、放射学检查结果和骨膜剥离检查结果，可以识别几乎所有口腔鳞癌病例的下颌侵犯。这有助于外科医生在术前和术中就下颌保留做出明智的决定。然而，在评估骨膜剥离的骨受累时应小心，因为由于担心肿瘤扩散和违反肿瘤学原理，因此不能推荐将其作为一种选择方法。 (C) 2009 年美国口腔颌面外科医师协会 J Oral Maxillofac Surg 67:1069-1073, 2009
Purpose: Invasion of the mandible by oral squamous carcinoma is not only a relative contraindication to mandible conservation but also an indicator of poor prognosis. This study looks at clinical, radiologic, and operative variables that may help in predicting mandibular bone involvement.Patients and Methods: A prospective study was carried Out to evaluate the mandibular involvement and its predictors in 51 cases of oral squamous carcinoma located in the mandibular region. All patients underwent segmental- or hemimandibulectomy. A detailed clinical examination was followed by radiologic assessment and operative assessment. Statistic analysis was carried out by chi(2) test (odds ratio [OR] with a significance level of 5%). Multivariate analysis was carried out by logistic regression analysis.Results: Univariate analysis identified location of tumor on lower alveolus (OR = 8.5), sensory disturbances of inferior alveolar nerve (OR = 16.2), location of tumor within 1 cm of mandible (OR = 1.4), presence of findings on periosteal striping (OR = 2.0) like subperiosteal reaction (OR = 3.5), cortical expansion (OR = 8.8) and presence of pathologic fracture (OR = 2.3) as predictor of bone invasion. Grade of tumor (P = .05) and radiologic bone involvement (P = .02) were found to be significant independent predictors of pathologic bone involvement on multivariate analysis.Conclusions: It is possible to identify mandibular invasion in almost all cases of oral squamous carcinoma by combining clinical examination, radiologic findings, and findings on periosteal stripping. This helps surgeons to make an informed preoperative and intraoperative decision about mandibular conservation. However, one should be careful when evaluating bone involvement on periosteal stripping as this cannot be recommended as a method of choice due to fear of tumor dissemination and violation of oncologic principles. (C) 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:1069-1073, 2009