Читать книгу Essential Cases in Head and Neck Oncology - Группа авторов - Страница 20

 Alveolus SCC is less common than tongue or floor of mouth cancers.

 Achieving negative margin resection (>5 mm) is an extremely important objective in the treatment of alveolar cancers.

 To achieve negative margin resection, most alveolar tumors will require resection of the underlying bone. Determining the extent of the mandibulectomy required to achieve negative margins can be challenging.

 It is accepted that if there is no bone erosion on CT or MRI, and there is enough height of the bone, marginal mandibulectomy can achieve negative margin resection. The remaining mandible should have at least a height of 1 cm.

 If there is bone erosion on CT imaging or MRI shows changes in the bone marrow signal, segmental mandibulectomy is recommended.

 There is no level I data on the best method to determine bone involvement. Cone beam CT is considered a very sensitive method.

 In good risk candidates, osseous reconstruction with fibula, scapula, or iliac crest free flap is recommended.

 Osteocutaneous radial forearm or vascularized rib graft has been described and used in patients who are not good candidates for fibula or scapula. However, the harvested bone is not thick enough to host implants.