Evidence for imaging the mandible in the management of oral squamous cell carcinoma: a review

The accuracy of clinical examination, peroperative periosteal stripping and imaging techniques in predicting tumour invasion of the mandible in oral cancer so far reported have been compared according to their specificity and sensitivity. Clinical examination alone was not shown to be accurate, but periosteal stripping at the time of resection was extremely accurate although so far only one study has investigated it. No single imaging technique will accurately predict the invasion of tumour into the mandible,,but a combination of an orthopantomogram and bone scintigraphy is recommended in early invasion. Magnetic resonance imaging is more sensitive than computed tomography and therefore may be more useful if mandibular invasion requires consideration. The decision to resect the mandible as part of the management of oral cancer should be taken on the evidence of clinical examination, periosteal stripping and at least two imaging techniques that complement each other in terms of specificity and sensitivity. (C) 2001 The British Association of Oral and Maxillofacial Surgeons.