The periosteum of the mandible and intraoral carcinoma

Preoperative assessment for and outcomes of mandibular conservation surgery

“…9 The lack of relationship between local recurrence and bone invasion in this study substantiates the findings in other studies. 10,11 In addition, the lack of association between pathologic bone invasion and regional recurrence clinically substantiates the work of Marchetta et al, 5 who demonstrated no correlation between periosteal involvement and cervical nodal metastases. Both studies contradict the theory that the lymphatic channels that course through the periosteum play a clinically significant role in metastasis.…”

“…Segmental mandibular resections were therefore frequently performed to prevent the eventual development of cervical metastases by way of the periosteal lymphatics. This generally held belief, which was published in 1902 by Polya and Navratil, 3 was considered``anatomical fact'' by Ward and Robben 4 and was not challenged until Marchetta et al 5 published their findings that the mandible was involved by tumor only if there was direct extension through the periosteum. Furthermore, he noted that there was no association between mandibular periosteal involvement and the presence of cervical nodal metastases.…”

Squamous Carcinomas of the Head and Neck: Some Patterns of Spread

“…The perineural spaces form a particularly important route ofspread oftumour into the mandi ble, a process which is aided by the realignment of the inferior dental canal and its contents that occurs in the edentulous atrophic mandible of elderly patients (Byars 1955, Lee & Wilson 1973. The importance of periosteal lymphatics as a mode of access for tumour is disputed (Marchetta et al 1964, Marchetta et al 1971.…”

Marginal Mandibulectomy vs Segmental Mandibulectomy

“…Unfortunately, the segmental mandibulectomy left the patient with a significant functional and aesthetic deficit. Once Marchetta et al 2 and Carter et al 3 demonstrated that cancer spreads to the mandible by direct invasion rather than lymphatic spread, preservation or partial resection of the mandible became oncologically feasible. The question became how to select appropriate patients with oral cancer for segmental or partial-thickness (marginal) mandibular resection.…”