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1 China Journal of Oral and Maxillofacial Surgery Vol.7 No.5 September [ ] (2009) ( ) [ ] : - (mandibular lingual releasing approach) : SPSS10.0 : 20 : (8 ) (6 ) (2 ) (4 ) I ~40 15 Kaplan-Meier % 64.9%(P=0.792);3 52.3% 50.0%(P=0.672) 40% 30%(P=0.501) : [ ] ; ; [ ] R739.8 [ ] A Mandibular lingual releasing approach to oral cancer: A new non-lip-split access ZHANG BinAN Chang-ming XU Zhen-gang TANG Ping-zhang. (Department of Head and Neck Surgery Cancer Hospital Chinese Academy of Medical Sciences Peking Union Medical College. Beijing China) [Abstract] PURPOSE: To evaluate the feasibility of mandibular lingual releasing approach to oral cancer without lip splitting and the oncological results. METHODS: A case-control study was undertaken for 20 patients with oral cancer who had mandibular lingual releasing procedures at this hospital between July of 2003 and December of Patients with lip-slitting procedures were randomly selected for control by matched age sex and stage. The complications local recurrence and survival result were compared. RESULTS: The subsides of primary tumor were floor of mouth (8) oral tongue (6) base of tongue (2) and others (4). The tumors were staged as follows: 2 in stage I 4 in stage II 6 in stage III and 8 in stage IV. The median follow up time was 15 months (range:1-40 months). The 3-year local control rate was 76.2% for the study group and 64.9% for the control group (P=0.792).The 3-year survival rate was 52.3% for the study group and 50.0% for the control group (P=0.672). The rate of complication was not significantly different (40% versus 30% P=0.501). CONCLUSIONS: This preliminary study shows that mandibular lingual releasing approach for oral cancer is oncologically safe compared to conventional lip split or mandibulotomy approach. This approach provides direct tumor visualization resection and reconstruction. Furthermore it avoids scar caused by lip splitting and may be beneficial to the quality of life. [Key words] Oral cancer; Surgical approach; Mandibular lingual releasing China J Oral Maxillofac Surg20097(5): [ ] ;[ ] [ ] (1963-) [ ] Tel: docbinzhang@hotmail.com c 2009

2 424. ZHANG Bin et al. Mandibular lingual releasing approach to oral cancer: A new non-lip-split access 9%~13% [1-3] ( ) 20 : 1 ;2 ;3 5 ;4 (I ) Table 1. Characteristics of the patients in two groups ; ( 1) ( 2) 1. ( / ) 16/4 16/4 ( / ) 56/34~74 55/39~79 Figure 1. Schematic diagram of oral mucoperiosteal incision: 8 8 either as a sulcular incision adjacent to teeth or a crest incision in 6 6 edentulous area. It started from one side of retromolar region to 2 3 the other side / / CT T1 3 3 T2 9 8 T3 4 7 T4 4 2 CN N0 9 8 N1 7 4 N ( / Gy) 59/50~70 55/40~70 ( / ) 33/1~40 45/1~ Figure 2. Mandibular lingual subperiosteal releasing. The tongue [1] and floor of mouth was pulled down into the neck to allow direct tumor resection

3 China Journal of Oral and Maxillofacial Surgery Vol.7 No.5 September mL ( 5) 4. 2 ( ) Table 4. Surgical complications ( ) SSPS 11.0 Kaplan- 2 2 Meier 8(40%) 6(30%) (terminal event) 5. χ 2 Table 5. Bleeding and duration of anesthesia t P< % (CI) ( ) Table 2. The type of tumor resection 1/ Table 3. Methods of reconstruction (40%) 6 (30%) ( 4)2 (χ 2 =1.026 P=0.501) Kaplan-Meier 76.2% % Log Rank 2 (Log Rank =0.07P=0.792) 2 t P (20 ) (20 ) (95%CI) (ml) (-148.1:103.1) (h) (0.29:2.72) Kaplan-Meier % %(Log Rank =0.18 P=0.672) ( 3 4) 85%2 ( 6)(P=0.845) 72 (P=0.889) 67 T3N2M Figure 3. The 14 th day post -operative view of a 67 -year -old 1.5h(95%CI: female with T3N2M0 oral tongue carcinoma. She underwent near total glossectomy and reconstruction with anterolateral thigh flap 0.29~2.72); through mandibular lingual releasing access

4 426. ZHANG Bin et al. Mandibular lingual releasing approach to oral cancer: A new non-lip-split access 3 :1 T1/T2 12 Devine T1 [6] T3/T (visor flap) 4 (pull-through) ( ) T2 T3 Marchetta [8] Stanley [4] 2 ( 2) (50%) 20% [5-6] 2 2 (76.2% 64.9%); 2 3 (52.3% 50.0%) 4. 2 Figure 4. Intraoral view of the same patient at the 14 th day after surgery 25% [4-5] 6. 2 Table 6. Restoration of oral feeding [7] 10% h 7. 2 Table 7. Restoration of speech (13 8) Stringer [5] 15 5

5 China Journal of Oral and Maxillofacial Surgery Vol.7 No.5 September [9] oropharyngeal tumors[j]. Am J Surg (4): [4] Stanley RB. Mandibular lingual releasing approach to oral and oropharyngeal carcinomas[j]. Laryngoscope198494(5 Pt 1):596- [10] [5] Stringer SP Jordan JR Mendenhall WM et al. Mandibular lingual releasing approach[j]. Otolaryngol Head Neck Surg (3): [6] Devine JC Rogers SN McNally D et al. A comparison of aesthetic functional and patient subjective outcomes following lip-split mandibulotomy and mandibular lingual releasing access procedures[j].int J Oral Maxillofac Surg200130(3): [7] Dean A Alamillos F Garcia-Lopez A et al. The use of Mitek pins in the mandibular lingual releasing approach to oral and/or oropharyngeal carcinomas: a technical note [J].J Craniomaxillofac Surg200028(5): [ ] [8] Marchetta FC Sako K Murphy JB. The periosteum of the mandible and intraoral carcinoma[j]. Am J Surg (9): [1] Dubner S Spiro RH.Median mandibulotomy:a critical assessment[j]. Head Neck (3): [J] (6): [2] Singh AM Bahadur S Tandon DA et al. Anteriormandibulotomy [10] Brown J Chatterjee R Lowe D et al. A new guide to mandibular for oral and oropharyngeal tumours [J].J Laryngol Otol resection for oral squamous cell carcinoma based on the Cawood (3): and Howell classification of the mandible[j]. Int J Oral Maxillofac [3] Spiro RH Gerold FP Shah JP et al. Mandibulotomy approach to Surg (10): [9]. Current Literatures 7 8 Optimizing systemic therapy in squamous cell carcinoma of the head and neck with a focus on targeted agents. Saba NF Khuri FR. Curr Opin Oncol (3): Docetaxel in the management of head and neck cancer. Caponigro F Longo F Perri F et al. Anticancer Drugs (8): (SCCHN) SCCHN FU (TPF ) Meta SCCHN SCCHN 20 ( ) SCCHN

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