Intraoperative evaluation of cortical bony margins with frozen-section analysis

OBJECTIVE: To describe and evaluate the efficacy of frozen-section analysis of cortical bone margins in surgery of the craniofacial skeleton. STUDY DESIGN: Retrospective analysis of a consecutive series of patients undergoing oncologic resection of various head and neck neoplasms with osseous involvement by the senior author (Y.D.) from 1998 to 2003. RESULTS: Frozen-section analysis of cortical bone was performed in 38 patients. Adequate specimens for histological analysis were obtained in all patients. Frozen sections were positive in 21 of 22 patients with bone invasion on decalcified specimens. After validating our technique for frozen analysis of cortical bone in 13 patients, the method had a sensitivity of 89% and a specificity of 100% in 25 patients. Malignancies diagnosed on frozen cortical bone specimens included squamous cell carcinoma (15), mucoepidermoid carcinoma (3), and sarcoma (3). Frozen cortical margins altered the extent of bony resection in 8 patients. CONCLUSION: A simple technique for analysis of cortical bone involvement by neoplasm is presented and reviewed. It allows for frozen-section analysis with standard equipment and appears to be a reliable method to evaluate bony margins intra-operatively. EBM rating: C-4 (C) 2006 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. All rights reserved.