A fit 63-year-old has a floor-of-mouth squamous cell carcinoma. CT and MRI show definite invasion through the lingual cortex into mandibular medullary bone over 2 cm, without distant disease. Which mandibular resection principle is most appropriate?
Definite mandibular medullary invasion requires continuity-interrupting segmental resection rather than a marginal procedure; vascularised reconstruction should be integrated into the oncological plan.
A. Strip the periosteum and leave the radiologically invaded mandible: This cannot clear established cortical and medullary disease.
B. Perform a marginal mandibulectomy preserving the inferior border despite medullary invasion: Marginal resection is considered for abutment or limited cortical involvement; medullary invasion risks an inadequate deep margin.
C. Use definitive chemoradiotherapy solely to avoid reconstruction: A reconstructable, resectable oral-cavity primary remains principally surgical in a fit patient.
D. Perform en-bloc segmental mandibulectomy with the primary tumour and plan vascularised bony reconstruction: Medullary invasion favours segmental resection for clearance; ablation and functional reconstruction should be planned together.
E. Remove the entire hemimandible including an uninvolved condyle in every case: Resection should encompass disease with an adequate margin, not sacrifice uninvolved structures automatically.
If the tumour merely abutted the mandible or caused limited superficial cortical erosion with adequate residual height, a continuity-preserving marginal approach could be considered if a clear margin remained achievable.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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