Vascular and pathological aspects of surgical conservation of the mandible in treatment of intra-oral cancer
Increasing cure rates following treatment for intra-oral squamous cell carcinoma have stimulated a desire to improve the cosmetic and functional results of surgery without compromising the surgical treatment of the disease. For many years, it was common practice to remove part of the mandible both to gain access to primary tumours of the oral cavity and to ensure complete removal of all disease, even though the bone was often not involved by tumour. This approach is falling into disfavour with increasing recognition that the key to both cosmesis and function is preservation of the manidble, either in part or in toto. Techniques have been developed which both improve access to the oral cavity by splitting the mandible and allow preservation of the lower border of the mandible when tumour has been found to work in practice, even in the absence of the inferior alveolar artery, but the vascular basis for this has not yet been clarified. The other fundamental on which such an approach must be based is an understanding of tumour entry and spread within the bone to define under what circumstances it is possible to adopt such a conservative approach. It was the purpose of this study to investigate the blood supply of the mandible, mechanisms of tumour entry and spread in the mandible and the effects on each of radiotherapy. This thesis reports the results of the investigation.