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CT Detection of Mandibular Invasion by Squamous Cell Carcinoma of the Oral Cavity

Suresh K. Mukherji1,2,3,4, David L. Isaacs1, Andrew Creager5, William Shockley2,3, Mark Weissler2,3 and Dianne Armao1

1 Department of Radiology, University of North Carolina School of Medicine, 3324 Old Infirmary CD# 7510, Chapel Hill, NC 27599-7510.
2 Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7510.
3 Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7510.
4 Present address: Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., UH B2B311-0030, Ann Arbor, MI 48109-0030.
5 Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7510.



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  		Fig. 1A. —Schematic illustrations of marginal and segmental mandibulectomy. Intraoral view depicts tumor located in floor of mouth.

 


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  		Fig. 1B. —Schematic illustrations of marginal and segmental mandibulectomy. Illustration drawn in coronal plane shows floor-of-mouth tumor that abuts but does not erode lingual cortex of mandible. Dashed line shows area of mandible that is resected in marginal (rim) mandibulectomy.

 


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  		Fig. 1C. —Schematic illustrations of marginal and segmental mandibulectomy. Illustration drawn in coronal plane shows another floor-of-mouth tumor that erodes lingual cortex of mandible and extends into medullary cavity. Dashed line shows that entire width of mandible is resected in segmental mandibulectomy.

 


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  		Fig. 2A. —True-positive CT findings in 66-year-old woman with anterior alveolar ridge carcinoma. Axial CT scan reconstructed with soft-tissue algorithm shows soft-tissue mass (arrows) in anterior alveolar ridge. Mass extends posteriorly into floor of mouth.

 


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  		Fig. 2B. —True-positive CT findings in 66-year-old woman with anterior alveolar ridge carcinoma. CT scan reconstructed with bone algorithm shows erosion of lingual and buccal cortex of mandible (arrows). CT scan was interpreted as showing mandibular invasion. Findings were histologically confirmed.

 


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  		Fig. 3A. —True-negative CT findings in 45-year-old man with anterior right floor-of-mouth carcinoma. Axial CT scan reconstructed with soft-tissue algorithm shows mass (arrowheads) in anterior portion of right floor of mouth.

 


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  		Fig. 3B. —True-negative CT findings in 45-year-old man with anterior right floor-of-mouth carcinoma. CT scan reconstructed with bone algorithm shows underlying lingual cortex (arrow) to be intact. CT scan was interpreted as showing no evidence of mandibular invasion. No tumor was identified on pathologic examination.

 


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  		Fig. 4A. —False-negative CT findings in 57-year-old man with superficial carcinoma on lingual surface of anterior alveolar ridge. No abnormal soft-tissue mass is detected on axial CT scan reconstructed with soft-tissue algorithm.

 


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  		Fig. 4B. —False-negative CT findings in 57-year-old man with superficial carcinoma on lingual surface of anterior alveolar ridge. CT scan reconstructed with bone algorithm shows small focal cortical defect (arrow) along lingual surface of alveolar ridge, which corresponded to tumor identified on clinical examination. Because no mass was seen on CT, loss of cortex (arrowheads) was thought to be due to periodontal disease and not neoplastic invasion. This patient was treated with marginal mandibulectomy with no tumor within surgical margins. Pathology revealed small focus of tumor within cortex of resected mandible. This misclassification could be attributed to an error in interpretation because erosion was attributed to periodontal disease and not bone erosion.

 


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  		Fig. 5A. —False-positive CT of 66-year-old man with left alveolar ridge carcinoma that extended inferiorly along buccal surface of mandible. Axial CT image that was reconstructed with soft-tissue algorithm shows mass (straight arrows) arising from buccal cortex of mandible. Note radiolucent plane (curved arrow) between deep margin of tumor and buccal cortex of mandible.

 


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  		Fig. 5B. —False-positive CT of 66-year-old man with left alveolar ridge carcinoma that extended inferiorly along buccal surface of mandible. CT scan reconstructed with bone algorithm shows scalloping of underlying mandible with thinning of cortex (arrows). CT scan was interpreted as showing mandibular invasion. However, no evidence of bony invasion was seen on pathologic examination. This may be due to regressive remodeling of periosteum without direct neoplastic invasion of cortex or medullary cavity.

 

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