Pathology of advanced buccal mucosa cancer involving masticator space (T4b).
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Date
2015-10
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Abstract
BACKGROUND: Buccal mucosa cancer involving masticator space is classified as very advanced local disease (T4b). The local recurrence rate is
very high due to poor understanding of the extent of tumor spread in masticator space and technically difficult surgical clearance. The objective of this
study is to understand the extent of tumor spread in masticator space to form basis for appropriate surgical resection. MATERIALS AND METHODS: All
consecutive patients with T4b‑buccal cancer underwent compartment resection, with complete anatomical removal of involved soft‑tissue structures.
Specimens were systematically studied to understand the extent of invasion of various structures. The findings of clinical history, imaging and
pathologic evaluation were compared and the results were evaluated. RESULTS: A total of 45 patients with advanced buccal cancer (T4b) were
included in this study. The skin, mandible and lymph nodes were involved in 30, 24 and 17 cases respectively. The pterygoid muscles were involved
in 34 cases (medial‑pterygoid in 12 and both pterygoids in 22 cases) and masseter‑muscle in 32 cases. Average distance for soft‑tissue margins
after compartment surgery was 2 cm and the margins were positive in 3 cases. The group with involvement of medial pterygoid muscle had safest
margin with compartment surgery while it was also possible to achieve negative margins for group involving lateral pterygoid muscle and plates.
The involvement of pterygomaxillary fissure was area of concern and margin was positive in 2 cases with one patient developing local recurrence
with intracranial extension. At 21 months median follow‑up (13‑35 months), 38 patients were alive without disease while two developed local
recurrence at the skull base.CONCLUSIONS: T4b buccal cancers have significant soft‑tissue involvement in the masticator space. En bloc removal
of all soft‑tissues in masticator space is advocated to remove tumor contained within space. The compartment surgery provides an opportunity
to achieve negative margins for cancers actually contained within masticator space.It is inappropriate to club all patients with masticator space
involvement in one group.
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Keywords
Buccal mucosa cancer, gingivobuccal sulcus, infratemporal fossa, masticator space, oral cancer, pterygoid muscles, retromolar trigone
Citation
Trivedi N P, Kekatpure V D, Shetkar G, Gangoli A, Kuriakose M A. Pathology of advanced buccal mucosa cancer involving masticator space (T4b). Indian Journal of Cancer. 2015 Oct-Dec; 52(4): 611-615.