Intraoperative Bone Marrow Frozen Sections Reduce Positive Final Margins in Mandibulectomy
In brief
In mandibulectomy, frozen sections linked to 1.1% vs 8.7% positive bone margins
In this single-center retrospective study, patients whose surgeons used intraoperative bone marrow frozen sections had fewer positive final bone margins than those without them: 1.1% versus 8.7%. The sections were highly concordant with final pathology, but their use was not linked to better survival among patients with squamous cell carcinoma, so whether improved margin control changes outcomes remains unknown.
- Journal
- The Laryngoscope (Q1)
- Published
- 21 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Amanda Wissmann Klage, Mitchell T Victor, Janice L Farlow, Tieying Hou, Jessica Yesensky, Avinash Mantravadi, et al.
- PMID
- 42905105
- DOI
- 10.1002/lary.71007
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (paper of the day, 24 October 2026): Frozen-section accuracy and final margin concordance in mandibulectomy
Abstract
OBJECTIVES: To assess the impact of intraoperative bone marrow frozen section (IBMFS) use on final margin status and survival outcomes in patients undergoing mandibulectomy for squamous cell carcinoma (SCC) and non-SCC neoplasms. METHODS: A single-center retrospective cohort study was performed of patients undergoing segmental or marginal mandibulectomy for benign or malignant neoplasms between 2009 and 2025. The medical record was reviewed for demographic data, histopathologic disease features, treatment, and outcomes. Univariable and multivariable Cox regression analyses were used to evaluate associations between IBMFS and recurrence-free and overall survival among patients with SCC. RESULTS: Of 235 cases, IBMFS were performed in 80.4%. IBMFS analysis was associated with reduced rates of positive final bone margins (1.1% vs. 8.7%, p = 0.014) and overall positive margins (7.9% vs. 19.6%, p = 0.029). Positive IBMFS rate was higher among non-SCC neoplasms than SCC (23.5% vs. 3.5%, p = 0.007), with no significant difference in rate of final positive margins. IBMFS results demonstrated 90.0% sensitivity, 99.4% specificity, and 98.9% concordance with final histopathology. Among SCC patients, IBMFS use was not significantly associated with recurrence-free survival (aHR 0.671, p = 0.320) or overall survival (aHR 0.967, p = 0.923); only nodal disease and age were significantly associated with survival. CONCLUSIONS: In this retrospective single-center cohort, IBMFS use was associated with improved final margin control across tumor types, including non-SCC neoplasms. Although no survival benefit was demonstrated, its association with margin clearance suggests that IBMFS may be a useful intraoperative adjunct in mandibulectomy for head and neck neoplasms.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.