Large oral cavity cancer with anterior mandible invasion: Describing radiographic and pathologic discrepancy

Abstract

Objectives: /Hypothesis—Large oral cavity carcinoma can invade the mandible in the absence of radiographic findings. We hypothesize that the anterior mandible is at a unique elevated risk of subclinical invasion secondary to specific anatomic factors, described herein. Methods: —Adult patients managed from January 2012 to April 2020 ​at two large academic medical centers with large oral cavity carcinoma abutting anterior mandible were reviewed. A review of our institutional free flap databases was conducted selecting for bony reconstruction of anterior mandible defects. Cases were selected that did not have bone invasion seen on preoperative imaging but did have pathologic bone invasion on final pathology. Results: —We present a Case series of four adult patients that were identified over the study duration. Subsites included three oral tongue and one floor of mouth. Three patients had squamous cell carcinoma and one patient had adenocarcinoma. Bony invasion was not appreciated on radiographic imaging, however final pathology demonstrated invasion in all patients. All patients had infiltrative pattern of mandibular invasion. Conclusions: —Mandible invasion, including presence of tumor in the medullary space, is possible even in the absence of radiographic bone invasion. The genial tubercle and lingual foramen may serve as an avenue of tumor spread into the anterior mandible from large oral cavity carcinoma. Surgical management of the mandible should be considered in select cases of large oral cavity carcinoma without radiographic evidence of mandible invasion.

Keywords

• Squamous cell carcinoma
• Mandible
• Imaging
• Histology
• Bone invasion