A systematic review of therapeutic outcomes following treatment of squamous cell carcinoma of the retromolar trigone

Abstract

Squamous cell carcinoma (SCC) of the retromolar trigone (RMT) is a rare but potentially fatal disease that carries a poor prognosis due to its unique anatomic position. RMT SCCs tend to spread to vital nearby structures, including the tonsillar pillar, masticatory muscles, and underlying mandibular bone, even in their early stages, and aggressive treatment is often warranted. This systematic review appraises and qualitatively analyzes all available literature regarding the survival outcomes and prognosis of RMT SCC. Four databases were searched to identify all eligible articles published since January 1980. Of the 1,248 studies, a total of 15 studies representing 4,838 cases met the inclusion criteria. The evaluated patients had a high rate of advanced tumor stage (T3 or T4: 61.4%), lymph node metastasis (38.8%), and mandibular bone invasion (24%) at the time of diagnosis. Aggressive surgical treatments such as lip-splitting (92%), segmental mandibulectomy (61.1%), radical neck dissection (44.1%), and reconstruction using free flaps (49.5%) was undertaken for 92% of the pooled patient population. The mean rates for local, regional, and systemic recurrence were 23.40%, 8.40%, and 8.50%, respectively. The mean 5-year overall survival rate was 38.90%. Osteonecrosis was noted in 11.6% of the 328 patients who received radiotherapy. In conclusion, RMT SCC is generally associated with high recurrence, low survival, and high postoperative complication rates. Early diagnosis and aggressive treatment are thus warranted. However, significant methodological problems hamper current knowledge. Future studies of this topic that use randomized or cohort designs are thus needed.

Demographic and pathologic factor regression to a growth rate model of p16‐negative oral cavity squamous cell carcinoma

“…Complex growth patterns arising from specific anatomic locales may introduce variability to the presented analysis. Specifically, tumor origination at the RMT results in complex tumor morphology and complex patterns of spread, limiting the rigor of analysis with CT and geometric simplification as presented in the current study 31 . Gadolinium‐enhanced 1.5 T MRI has been shown to identify tumor stage of RMT tumors with high accuracy, specificity, and sensitivity and may play a role in future of longitudinal growth anlysis in vivo, ahead of surgical resection 32 .…”

“…Specifically, tumor origination at the RMT results in complex tumor morphology and complex patterns of spread, limiting the rigor of analysis with CT and geometric simplification as presented in the current study. 31 Gadolinium‐enhanced 1.5 T MRI has been shown to identify tumor stage of RMT tumors with high accuracy, specificity, and sensitivity and may play a role in future of longitudinal growth anlysis in vivo, ahead of surgical resection. 32 Additionally, previous correlates of MR data with post‐resection pathologic samples are well validated, potentially improving the extrinsic validity of this comparison based methodology.…”

Lymph node metastasis in oral squamous cell carcinoma: Where we are and where we are going

“…According to recent large‐scale studies, the rates of LNM in OSCC across different primary sites are as follows: buccal mucosa‐42%; lower alveolus‐28%; retromolar‐48%; floor of mouth‐45%; tongue‐45%; mucosal lip‐16%; upper oral cavity‐38% (Figure 3). 29–32 As previously mentioned, lymphatic drainage from OSCC typically first reaches levels I and II lymph nodes before progressing to level III. The ‘cascade theory’ 33 indicate that OSCC LNM should first appears in proximate levels I, II and III lymph nodes, with fewer metastases in level IV and V. A recent large‐scale study indicate that 91% of LNM in OSCC occur in levels I, II and III, while metastasis rates in levels IV and V are relatively low at 4.7% and 3.3%, respectively 34 .…”