Imaging in Oral Cavity Cancer

The proximity or direct extension of a primary tumor of the oral cavity to the mandible requires appropriate radiological studies to establish the presence and extent of bone involvement.

• Although the absence of radiographic findings does not rule out bone invasion, bone destruction as seen on the radiograph confirms tumor invasion.

Radionuclide bone scans often are positive before the radiographic appearance of bone destruction, but they seldom provide accurate information regarding the extent of bone invasion.

• Bone scans also may be positive in non-neoplastic conditions, such as inflammatory lesions.

Plain radiographs of the mandible in the antero-posterior and oblique views are not satisfactory as a routine screening test to establish or rule out bone destruction.

A panoramic view of the mandible (an orthopantomogram) is helpful to assess the general architecture of the mandible in relation to the dento-alveolar structures and invasion by the tumor (Figure).

• However, for technical reasons, the midline of the mandible near the symphysis is not adequately evaluated by a panoramic view.

• In addition, early invasion of the lingual cortex of the mandible is not seen on a panoramic view.

• Occlusal films of the body of the mandible and intraoral dental films often are most accurate in demonstrating early invasion by a tumor.

Computerized tomograms of the mandible generally are not optimal for routine screening but may be considered in certain circumstances, such as primary tumors of the mandible and lesions where soft tissue extension from tumors involving the ascending ramus of the mandible is suspected (Figure).

Three-dimensional reconstructions of CT images provide an excellent overview of the mandible or maxilla from any desired angle.

• Three-dimensional reconstructions of the mandible of a patient with an ossifying fibroma of the body of the mandible on the left-hand side causing expansion and involving the lingual cortex are shown in the Figures.

• A three-dimensional CT scan and a one-to-one reproduction of the CT scan are of great value to the surgeon for mandible reconstruction with a microvascular free flap.

• These images are essential to fabricate and shape the graft to match the resected

  portion of the mandible.

  Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center.

  He is first author on some publications on oral cavity cancer:

  • Oral Tongue Cancer: Literature Review and Current Management 

    • https://www.oatext.com/pdf/CRR-2-153.pdf

  • Understand Cancer: Research and Treatment Oral Cavity Cancer: Literature Review and Current Management. 

    • https://www.researchgate.net/publication/303366031_Understand_Cancer_Research_and_Treatment_Oral_Cavity_Cancer_Literature_Review_and_Current_Management

  Training:

  • General surgery:

  • Michigan State University:

  • 2004 al 2010

  

  • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

  • Fox Chase Cancer Center (Filadelfia):

  • 2010 al 2012

  

  • Masters in Science (Clinical research for health professionals):

  • Drexel University (Filadelfia):

  • 2010 al 2012

  

  • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

  • IFHNOS / Memorial Sloan Kettering Cancer Center:

  • 2014 al 2016