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April 1991

Immediate and Delayed Mandibular Reconstruction

Author Affiliations

London, England

Arch Otolaryngol Head Neck Surg. 1991;117(4):450. doi:10.1001/archotol.1991.01870160104020

To the Editor.—We read the article entitled "A Critical Analysis of Immediate and Delayed Mandibular Reconstruction Using A-0 Plates" by A. Komisar et al with concern.1 The authors presented a very gloomy outlook for T2 and T3 squamous carcinomas of the oral cavity treated by primary surgery and mandibulectomy. With only two patients out of 10 alive and disease free at 3 years their treatment policy must be called into question.

We have reported our experience of treating 147 tongue and floor of mouth carcinomas2 using interstitial and external beam radiotherapy. In 71 T2 tumors treated in this way, 25% of the patients had recurrence at the primary site, and 67% were alive and disease free at 5 years; this fell to 47% in the 26 lesions staged T3 and T4.

Where surgery has been indicated, we have found that mandibular resection is unnecessary in the majority