Mandibulotomy for The Approach to The Oral Cavity, Oropharynx and Skull Base

Lee, Hyung Seok; Tae, Kyung; Shim, Bong Taek; Kwon, Son Wuk; Ahn, Kyung Sung

Abstract

BACKGROUND: Adequate exposure of skull base lesion and intraoral lesion occupying the posterior oral cavity, base of tongue, tonsil, superior hypopharynx, anterior skull base, and infratemporal space for wide-field primary surgical resection is critical to tumor ablation. The division of mandible for resection of tumor was first undertaken by Roux in 1836, and many studies renewed the interest of mandible sparing procedure for surgical treatment of oropharyngeal carcinoma.
OBJECTIVES
Mandibular swing approach for gaining access to oral cavity, oropharynx, and skull base for excision of tumor, provides excellent exposure with low complication rate when there is intervening grossly normal tissue between the tumor and bone. We studied mandibular swing approach with our surgical experience, with special emphasis on its subtypes related to osteotomy sites and forms. MATERIALS AND METHOD: The records of 20 patients underwent mandibular swing approach at Hanyang University Hospital, were studied by chart review. The patients were retrospectively reviewed to assess age, sex, tumor site origin, stage of disease, types of neck dissection and methods of the reconstruction, types of the mandibular osteotomies, and difference of complication rates between symphyseal and parasymphyseal osteotomy.
RESULTS
Post-operative complications occured in 6 patients(30%). But osteotomy related complication rate was 15%. Complications of osteotomy site occurred at a rate of 20% in the symphyseal osteotomy group, but no complications arose in parasymphyseal osteotomy group.
CONCLUSIONS
We believe that, if the mandible is clinically and radiologically clear of malignant involvement, midline mandibulotomy is more feasible surgical approach method for treatment of oral cavity, oropharyngeal, skull base lesion.