A 60-year-old male tobacco user has a 2 cm squamous cell carcinoma of the gingivobuccal complex abutting the mandible. CT shows erosion limited to the outer cortical plate with no marrow involvement and an intact inferior alveolar canal. What is the most appropriate management of the mandible?

• A No bone resection since cortical erosion indicates inflammatory change
• B Segmental mandibulectomy with fibula free flap reconstruction
• C Periosteal stripping alone with preservation of all cortical bone
• D Marginal (rim) mandibulectomy with the soft tissue specimen ✓

Explanation

Erosion confined to the outer cortex without extension into the medullary cavity permits marginal mandibulectomy, preserving mandibular continuity, occlusion and function. Segmental resection with reconstruction is required once tumour enters the marrow, reaches the inferior alveolar canal, or breaches both cortices. Periosteal stripping alone leaves macroscopically involved cortical bone behind and invites recurrence at the mandible, making it unsafe in proven cortical erosion.

Reference: Cummings Otolaryngology Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.