Surgical Margins in 3D Planned Mandibular Resections for Squamous Cell Carcinomas of the Oral Cavity

Abstract

Purpose: Three-dimensional (3D) planned mandibular resections using cutting guides and preplanned plates are now widely used in oncological surgery. The main advantages are the gain of time, precision, and esthetic outcomes. The drawbacks include costs, time for planning, and printing the surgical tools. This time between the radiological data and the surgery may allow tumor progression, rendering the custom-made guides useless. There is no consensus regarding surgical margins that should be planned to ensure a safe oncologic outcome. The purpose of this retrospective study is to evaluate if the planned bony margins are adequate. Materials and Methods: Inclusion criteria were: Squamous cell carcinomas of the anterior and lateral floor of mouth with mandibular invasion (T4); mandibular resection using 3D planning and cutting guides. Between June 2015 to December 2019, 16 patients met the criteria. The time between the planning and the surgery was recorded. The authors decided to use a margin of at least 1 cm on the preoperative computerized tomography scans on each side of the tumors in our planning for all patients. The authors then measured the distance of the bone resection on the pathological specimen. Results: All 16 patients had safe bone surgical margins (R0). The average time from the scanners used for the planning to the surgery was 33 days. Discussion: All the cutting guides could be used. The pathology examination showed safe oncological margins and no patients required further resection. A 1 cm margin during 3D planning for mandibular resections with 3D printed cutting guides, in patients with T4 Squamous Cell Carcinomas can therefore be considered safe.