Chapter 89 - Part A: Margins Are Not Enough: The Mental Model of Jaw Resection

In this BoardsCast episode, we begin Tobias Chapter 89 - Mandibulectomy and Maxillectomy by addressing one of the biggest misconceptions in oral oncology:
jaw resections are not about margins — they’re about mechanics, stability, function, and reconstruction.

While margins determine oncologic success, they tell you nothing about whether the patient will still be able to eat, breathe, swallow, and function normally afterward. Bone cuts, occlusion, vascular supply, load distribution, and mandibular dynamics matter just as much — and sometimes even more.

You’ll learn:

• Why margins alone are an incomplete surgical plan
• How to build a mental model of mandibular and maxillary biomechanics
• The difference between partial, segmental, and total mandibulectomy
• Why unilateral vs bilateral resections have drastically different outcomes
• How occlusal forces destabilize closures after bone removal
• What structures you must preserve to prevent catastrophic dysfunction
• Board-relevant patterns for mandibular tumors, bone invasion, and reconstruction
• Why “successful resection” can still lead to a nonfunctional, failing patient

This episode reframes jaw surgery from a “cut-it-out” procedure to a three-dimensional biomechanical problem — the mindset the boards expect.

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Listen On: Spotify | Apple Podcasts | Amazon Music

Chapters

• 0:00 Introduction: The "Clean Margin" Paradox
• 1:00 New Mental Model: Biologic Barrier Management
• 2:30 The Anatomy of Spread: Why oral tumors are 3D icebergs
• 4:15 The Mandibular Canal: The high-speed conduit for recurrence
• 6:00 Barriers vs. Highways: How to prioritize deep margins
• 8:15 Perineural Invasion: When the tumor hijacks the nerve sheath
• 10:45 The Bone Rule: Assume invasion regardless of the X-ray
• 13:00 Decision Mastery: When the best margin is a more radical resection