Understanding the impact of mandibular invasion on oral squamous cell carcinoma: A clinicoradiopathological perspective

In Head and neck squamous cell carcinoma (HNSCC), the clinical assessment of mandibular involvement is often inaccurate and unreliable. Involvement of mandible, upstages the disease to stage IV. An important role of imaging in evaluating patients with SCC of the oral cavity is to evaluate the presence and extent of mandibular bone invasion. AIM-To determine the correlation between clinical, radiological and pathological findings in detecting mandibular invasion by squamous cell carcinoma in oral cavity. METHODOLOGY - Prospective study including patients who presented to Head and Neck oncology clinic, RCC TRIVANDRUM, with squamous cell carcinoma of the oral cavity with tumour clinically fixed to or near to mandible in biopsy proven SCC planned for treatment as per department protocol. RESULTS- 131 patients were studied in 1 year, out of which 79 percent were males, 40 percent had clinical bone erosion, and 34 percent had radiological bone erosion. SENSITIVITY of CT - 88%, SPECIFICITY-77.4%, PPV-47.8%, NPV-96.5%, ACCURACY - 79.4%. CONCLUSION-Precise assessment of the extent of mandibular invasion is therefore important for treatment planning to obtain both tumour resection and good functional results of jaw. CT scan is a sensitive tool for predicting bone erosion and should be routinely used in all cases of oral cavity malignancy and combined with thorough clinical examination.