Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias da Língua/cirurgia , Adulto , Idoso , Feminino , Neoplasias de Cabeça e Pescoço , Humanos , Laringectomia , Masculino , Mandíbula/cirurgia , Métodos , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Osteotomia , Faringe/cirurgia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Neoplasias da Língua/radioterapiaRESUMO
The composite resection operation with sacrifice of a portion of the hemimandible is considered to be the fundamental operation for cancers in the posterior oral cavity. The mandible is resected for cancer control (to ease reconstruction) and perhaps for traditional reasons. Mandibular sacrifice is not always essential for oncologic resection. Access through the mandible is usually required for effective resection of cancers in this region. The lateral mandibular osteotomy approach provides this access in selected patients. The adjacent, remaining portion of the tongue provides 75 to 100 sq cm of thick pliable vascular mucosa that can be used for closing the defects after resection of the cancer in the posterior oral cavity. As much as one half of the tongue can be rotated. If certain precautions are taken, a viable flap can be assured even after radiation treatment or ligation of the ipsilateral lingual artery.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Mandíbula/cirurgia , Neoplasias Bucais/cirurgia , Osteotomia/métodos , Língua/cirurgia , Humanos , Neoplasias da Língua/cirurgiaRESUMO
The records of 66 patients with osteosarcoma of the jaw were reviewed. The ages of the 42 males and 24 females ranged from 12 to 79 years (mean, 34.2 years). Swelling and pain, the most frequent presenting complaints, were noted an average of three months before the patient was seen by a physician. Fifty-one percent of the lesions involved the maxilla and 49% involved the mandible. The most common sites of involvement were the body of the mandible and the alveolar ridge of the maxilla. Radiologically, most of the lesions in the maxilla were osteoblastic (50%), whereas most of those in the mandible were osteolytic (43%). Chondroblastic osteosarcoma was the most frequent histologic type (48%) and was associated with the best survival rate (47%). Treatment included radical and local surgery with radiotherapy, chemotherapy, or various combinations. The recurrence rate for all treatment modalities was 70%. Patients treated by initial radical surgery had the best survival (80%). Survival decreased to 27% with local surgery. Of the 43 (65%) patients who died, most died with uncontrolled local disease; only four patients had documented distant metastasis, which involved lung, cervical lymph nodes, spinal column, and brain.