Management of oromandibular cancers.

OBJECTIVE: To emphasize the role and importance of multidisciplinary approach in the management of oral cavity cancers involving the mandible. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The Departments of Plastic and Reconstructive Surgery, ENT / Head and Neck Surgery and Radiation Oncology, Combined Military Hospital, Rawalpindi. Duration spans over a period of six years. SUBJECTS AND METHODS: A total of 63 patients who had biopsy-proven oromandibular tumors, after thorough assessment / staging in Joint Head and Neck Oncology Clinic, underwent resection and reconstruction for malignant oral cavity tumors involving the mandible were included in the study. All the resected tumor specimen were sent for histopathology. All the post-resection defects were properly classified and reconstructed by the plastic surgery team. Postoperatively, all the patients underwent adjuvant full dose radiotherapy at the Department of Radiation Oncology. Complications were recorded and managed accordingly. At one year follow-up all the available patients were assessed for functional and aesthetic restoration and recurrences. RESULTS: Out of 63 patients there were 40 males and 23 females (ratio 1.7 : 1) with an average age of 50 years. Tumor-free resection margins could be achieved in 56 patients. In 88% cases tumor was a Squamous cell carcinoma. Radical neck dissections were carried on in 27 patients. Radial forearm free flap was used in 27 patients, pectoralis major myocutaneous flap in 19, free fibula osteocutaneous flap in 10, rectus-abdominis myocutaneous free flap with Implant was used in 3 patients to reconstruct the post-resection defects. There was only one total flap loss and 3 partial flap losses. Implant exposure was encountered in 4 instances with 3 major and 5 minor fistulae. At one year follow-up, 56 patients were available. Thirty-seven patients had intelligible speech, 15 patients were taking normal diet and in 33 patients there was a satisfactory mandibular contour restoration. Seven patients had recurrences, 2 were not traceable and 5 patients had died by that time. CONCLUSION: A multidisciplinary collaboration is the key to effectively manage this group of extremely debilitating malignancies.