Carcinoma involving the lower alveolus an appraisal of past results and an account of current management

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Abstract
Three hundred and fifty-six cases of carcinoma of the buccal mucosa, lower alveolus, and mouth floor treated under a policy of radiotherapy as the method of first choice are reviewed. Alveolar involvement, whether initial or by extension, greatly reduces the chance of radiotherapeutic success, and is more important in this respect than the exact site of origin of the tumour. A decision to switch to a trial of elective surgery in this group of cases with alveolar in involvement was strengthened by major advances in surgical management, especially the evolution of satisfactory techniques of repair. A cardinal point is that tumour excision and closure of the mouth defect can now be accomplished reliably in one stage. The uses of the ‘island’ forehead flap and of Bakamjian's deltopectoral flap are discussed, as well as the methods of providing mandibular support when necessary. The authors' current techniques are described in detail on the basis of 82 consecutive radical procedures. A preliminary survey of the results suggests that surgery in this group may yield better results than radiotherapy.