Carcinoma involving the lower alveolus an appraisal of past results and an account of current management

Abstract

Three hundred and fifty‐six cases of carcinoma of the buccal mucosa, lower alveolus, and mouth floor treated under a policy of radiotherapy as the method of first choice are reviewed. Alveolar involvement, whether initial or by extension, greatly reduces the chance of radiotherapeutic success, and is more important in this respect than the exact site of origin of the tumour. A decision to switch to a trial of elective surgery in this group of cases with alveolar in involvement was strengthened by major advances in surgical management, especially the evolution of satisfactory techniques of repair. A cardinal point is that tumour excision and closure of the mouth defect can now be accomplished reliably in one stage. The uses of the ‘island’ forehead flap and of Bakamjian's deltopectoral flap are discussed, as well as the methods of providing mandibular support when necessary. The authors' current techniques are described in detail on the basis of 82 consecutive radical procedures. A preliminary survey of the results suggests that surgery in this group may yield better results than radiotherapy.

Carcinoma of the tongue: Factors affecting the results of surgical treatment

“…This unfortunately may have resulted in deformity and dysfunction and a higher rate of breakdown of the suture line, leading to salivary fistula. Development of the use of pedicle flaps is a step forward towards success in surgical treatment of carcinoma of the oral cavity (7).…”

Temporal artery‐based forehead flap

“…Major tissue loss occurred in 2 cases. Other complications were minor tissue loss (4), skin-graft failure (7)) hair within the mouth (2)) and transient facial-nerve paralysis (3). Tissue Loss.…”

Intraoral Malignancy with Special Reference to Jaw Replacement

“…The provision of a definitive bone graft often failed to correct the deformities and intraoral function was poor. Indeed a proportion of these patients presented the picture of oral crippling that was so well described by Conley in 1962. The introduction of intraoral lining by a regional flap with sufficient fat, adequate to fill the 'tissue vacuum', allows mobility of the tongue and floor of mouth for speech and mastication (Lee & Wilson 1973). In many cases an accept- fracture ofthe left mandible able degree of restoration of contour is achieved.…”