Use of a Transbuccal Technique for Marginal Mandibulectomy: A Novel Approach

Endoscopically Assisted Marginal Mandibulectomy Using an Intraoral Approach Alone for Squamous Cell Carcinoma of the Posterior Mandibular Gingiva: A Technical Note

Study Design

Technical note.

Objective

Marginal mandibulectomy is a surgical procedure for treatment of mandibular gingival tumors. The intraoral approach to the posterior region of the mandible for marginal mandibulectomy is difficult due to limited access and operating field visibility; the conventional surgical procedure may require some skin incisions. This report discusses the effectiveness of endoscopic assistance in marginal mandibulectomy.

Methods

This article describes endoscopically assisted marginal mandibulectomy using an intraoral approach alone for squamous cell carcinoma of the posterior mandibular gingiva.

Results

The advantages of this surgical method are twofold: (1) superior visibility to the lower edge of the mandible without any skin incision; and (2) safe surgical confirmation of important anatomy on the buccolingual side (e.g., mental foramen, lingual nerve, mandibular foramen, and neurovascular bundle). This minimally invasive approach without any skin incision, as well as the superior visibility of the operating field, are important advantages of endoscopically assisted marginal mandibulectomy that cannot be obtained by other surgical methods.

Conclusions

Endoscopically assisted marginal mandibulectomy using an intraoral approach alone may be useful because it avoids damage to facial skin and improves safety by employing an enlarged bright field.

Lateral Approach With a Mouth Corner Incision for the Molar Part of Mandibulectomy

OBJECTIVES

The aim of the present study was to evaluate the functional and esthetic results of marginal mandibulectomy for mandibular cancer using a lateral approach with a simple, straightforward mouth corner incision.

STUDY DESIGN

Six mandibular cancer patients (2 men, 4 women; age range: 65-80 years; mean age, 73.1 years; all stage I) were treated using this approach. With this approach, the surgical field was widely exposed, and mandibulectomy was performed with sufficient surgical margins. Intraoperative frozen specimens of remaining tissues showed no malignancy in all cases. In all 6 patients, follow-up imaging assessments were obtained, with no local recurrence after 12 to 78 months.

RESULTS AND CONCLUSIONS

An overall functional, physical, and esthetic assessment of oral behavior and oral appearance was made of all patients by the FACT-H&N questionnaire, which showed that functional lip behavior and esthetic lip appearance were not much affected by the present surgical approach, and good quality of life was maintained. Thus, the lateral approach with the mouth corner incision is an effective and useful alternative for the molar part of mandibulectomy.

Cheek-splitting technique for marginal mandibulectomy: A novel approach

When performing marginal mandibulectomy, ensuring complete tumor removal and preventing postoperative iatrogenic mandibular fracture are essential. Pathological fracture can result due to stress concentration at the site requiring acute angle resection. To perform marginal mandibulectomy without making acute angles in patients with a lesion in the molar or more posterior region, a submandibular or transbuccal approach is necessary. Compared to the submandibular approach, the transbuccal approach is considered useful as it reduces operative time and prevents injury to the facial and mental nerves. Additionally, this approach does not leave a scar in the surgical field, which is beneficial in subsequent neck dissection for late neck metastasis. Here, we report 2 cases of lower gingival carcinoma in which satisfactory aesthetic outcomes were achieved with an improved cheek-splitting technique for marginal mandibulectomy using a transbuccal approach, taking into consideration the angle of the mouth, design of the triangular flap, and modiolus.

Key words:Mandibular gingival carcinoma, cheek-splitting technique, transbuccal approach, marginal mandibulectomy.