Tooth mobility: A plausible predictor of bony margins

2019-22-06 Dentistry

Sir, we read the article by Singh et al. [1] with great interest and would like to add further to the existing literature. Mucosal margins and bony margins are independent prognostic entities [2], the nature of tumour spread depends on its composition (presence or absence of neurovascular involvement [3], microvascular density [4], bone density), location, tumour biology, host factors and the overall treatment time [5,6]. There is a unanimous agreement in the literature regarding post resection overall margins (bony + mucosal) and its further management, however there has been a dearth of studies on bony margins, its behaviour in the presence of positivity. Mandibular bone erosion and medullary infiltration show a distinct cellular and molecular mechanism [7]. A lack of local disease control by an incomplete resection is catastrophic considering the fact that Oral cancer is known for its loco-regional invasion. The general consensus in oncology is the tumour to be resected with clear margins with no compromise in the oncological clearance. Nonetheless, a yardstick of 5mm clear margins [8] from the tumour to the edge of the specimen may not be universally applicable in all subsites of the Head and Neck region. An anatomical method assumed to be the most predictable for surgical clearance is if the tumour breaches a particular tissue plane, it is wise to leap into the next anatomical tissue plane. This is in contrast to bony margins that lack the distinct anatomic planes, precludes the use of a tumour free margin for rapid frozen section and carry significant morbidity in terms of speech, swallow and mastication with an aggressive bony resection.