[Treatment of malpighian epitheliomas of the floor of the mouth with gingival involvement].

Within the clinical context of carinomas of the upper respiratory/digestive tract (special underlying features, frequency of multiple localisations), pelvi-gingival tumours pose special problems essentially related to the proximity of the mandible. Over the past 15 years, treatment protocols at the Institut Gustave-Roussy have been progressively oriented towards a surgical solution preceded by short period of chemotherapy and followed by radiotherapy on an "as required" basis. In certain instances (bone resection with defect, especially naterior), such excision surgery results in serious functional and aesthetic impairment and cannot be envisaged in the absence of concomitant reparative surgery. The latter is clearly defined as far as the soft tissues are concerned thanks to the use of facial or thoracic flaps, whilst solutions for restoring bone continuity remain imperfect. The difficulties of covering a bone transplant and the need for postoperative radiotherapy compromise its future. From a tumour standpoint, the results are aggravated essentially by the existence of bone involvement or of histological lymph node invasion. Furthermore, it is closely related to the manifestations of the malignant disease in general. The survival obtained with the current therapeutic protocol is 38% at 3 years and 32% at 5 years.