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Faisal M, Seemann R, Fischer G, Lill C, Hamzavi S, Wutzl A, Erovic BM. Neurological Complications in Benign Parapharyngeal Space Tumors - Systematic Review and Meta-Analysis. Int Arch Otorhinolaryngol 2022; 27:e158-e165. [PMID: 36714902 PMCID: PMC9879647 DOI: 10.1055/s-0042-1744164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/16/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Parapharyngeal space tumors with complex anatomy and diverse histology have remained a challenging phenomenon for treating physicians. Objectives We have conducted a comprehensive web search on the PubMed, Web of Science, EMBASE, Cochrane Library, Biomedical Literature Database (CBM), and Clinicaltrials.gov databases to determine the factors that are associated with postoperative complications in parapharyngeal space tumors. Data Synthesis Two researchers reviewed all identified articles independently with a third reviewer for adjudication. Patient demographics and other clinicopathological characteristics were explored. The systematic review has identified 631 benign parapharyngeal space tumors with neurogenic and salivary tissue histology in 13 studies, with a mean age of 42.9 ± 7.76 years old and a median follow-up of 40.98 ± 19.1 months. Salivary gland (50.8%) and neurogenic (49.1%) tumors were the most common histological entities. Tumor size, location, histology, deep parotid lobe involvement, and proximity to great vessels or to the skull base were the deciding factors in selecting the surgical approach. The factors considered to select the surgical approach do not seem to have a correlation with the outcome in terms of neurological sequalae ( p = 0.106). Tumors with neurogenic histology have significantly increased chances of developing neurological complication (OR 6.07; p = 0.001). Conclusion Neurologic complications are significantly associated with neurogenic benign tumors rather than surgical approach.
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Affiliation(s)
- Muhammad Faisal
- Shaukat Khanum Memorial Cancer Hosital and Research Centre, Lahore, Pakistan,Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria,Address for correspondence Muhammad Faisal, BDS, FCPS (OMFS), FHNS (AT) Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre7-A, Block R3, Johar Town, Lahore, Pakistan
| | - Rudolf Seemann
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Gregor Fischer
- Department of ENT, Danube University, Krems Faculty of Health and Medicine, Krems, Niederösterreich, Austria
| | - Claudia Lill
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Sasan Hamzavi
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Arno Wutzl
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Boban M. Erovic
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
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Hedayat F, Jerry Htwe KK, Vassiliou LV, Kyzas P. Morbidity related to the lip-split mandibulotomy approach: a systematic and narrative review. Br J Oral Maxillofac Surg 2021; 60:430-436. [PMID: 35184915 DOI: 10.1016/j.bjoms.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/21/2021] [Indexed: 01/04/2023]
Abstract
The lip-split mandibulotomy (LSMA) is an access procedure that has been used in head and neck (H&N) surgery as an aid to surgical resection of inaccessible tumours of the postertior oral cavity and oropharynx. Anecdotal evidence suggests that it has significant morbidity. Voices of concern within the H&N surgical community suggest that it has been abandoned in favour of technological advances such as robotic surgery. We report here the first (to our knowledge) registered systematic review of its kind, documenting the safety and efficiency of LSMA in H&N surgery. We performed a PRISMA-guided systematic review (PROSPERO-registered) and identified reports using a search algorithm in MEDLINE/EMBASE. LSMA-related surgical complications were recorded using the Clavien-Dindo classification. Secondary outcomes included swallowing dysfunction, facial cosmesis, and patient satisfaction recorded in health-related quality of life questionnaires (HRQoL). From 125 studies identified, 54 met the inclusion criteria (3872 patients). The LSMA mortality rate was 0%; we did not identify a single case of perioperative death. The median rate of osteoradionecrosis was 5.4%, whereas fistula formation was 5.7%. Malunion was noted in 4.9%. Other complications (surgical site infection, plate exposure) were around 5%. There was significant between-study variation with regards to swallowing assessment tools, but overall there was no significant difference in outcomes. This was also the case for the HRQoL questionairres. LSMA is a safe procedure with an acceptable rate of complications, and should definitely remain in the armamentarium of H&N surgery.
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Affiliation(s)
- Fatemeh Hedayat
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Ko Ko Jerry Htwe
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Leandros-Vassilios Vassiliou
- School of Medicine, University of Central Lancashire, Preston, United Kingdom; Department of Oral and Maxillofacial Surgery, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
| | - Panayiotis Kyzas
- School of Medicine, University of Central Lancashire, Preston, United Kingdom; Department of Oral and Maxillofacial Surgery, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom.
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Munhoz L, Nishimura DA, Iida CH, Watanabe PCA, Arita ES. Head and neck radiotherapy-induced changes in dentomaxillofacial structures detected on panoramic radiographs: A systematic review. Imaging Sci Dent 2021; 51:223-235. [PMID: 34621649 PMCID: PMC8479433 DOI: 10.5624/isd.20210011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/17/2021] [Accepted: 02/26/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to summarize the impact of neck and head radiation treatment on maxillofacial structures detected on panoramic radiographs. Materials and Methods In this systematic review, the authors searched PubMed Central, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar for original research studies up to February 2020 that included the following Medical Subject Headings keywords: words related to “radiotherapy” and synonyms combined with keywords related to “panoramic radiography” and “oral diagnosis” and synonyms. Only original studies in English that investigated the maxillofacial effects of radiotherapy via panoramic radiographs were included. The quality of the selected manuscripts was evaluated by assessing the risk of bias using Cochrane's ROBINS-I tool for non-randomized studies. Results Thirty-three studies were eligible and included in this review. The main objectives pertained to the assessment of the effects of radiation on maxillofacial structures, including bone architecture alterations, periodontal space widening, teeth development abnormalities, osteoradionecrosis, and implant bone loss. The number of participants evaluated ranged from 8 to 176. Conclusion The interaction between ionizing radiation and maxillofacial structures results in hazard to the tissues involved, particularly the bone tissue, periosteum, connective tissue of the mucosa, and endothelium. Hard tissue changes due to radiation therapy can be detected on panoramic radiographs.
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Affiliation(s)
- Luciana Munhoz
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | | | - Christyan Hiroshi Iida
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Plauto Christopher Aranha Watanabe
- Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, Brazil
| | - Emiko Saito Arita
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Böger D, Hartmann R, Sauer M. [Critical aspects of the transmandibular approach to the oral cavity and oropharynx]. HNO 2021; 70:110-116. [PMID: 34170338 DOI: 10.1007/s00106-021-01073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the context of tumor surgery, the median mandibulotomy as an access route to the oral cavity and oropharynx provides an excellent overview of the surgical site. However, it is not regarded entirely unproblematic with regard to early and later complications that may arise. OBJECTIVE The results and complications of the median mandibulotomy will be presented based on data collected from our own patient collective. MATERIALS AND METHODS A total of 21 patients who had undergone a median mandibulotomy as part of tumor surgery at the Department of Otorhinolaryngology of the SRH Zentralklinikum Suhl were examined over a period from 01 January 2010 to 31 December 2020. The patient files were retrospectively evaluated. RESULTS A stair-step median mandibulotomy was performed in all 21 patients. Reconstruction was performed using a 2.8 mm thick angled mandibular plate and bicortical locking screws. The mean follow-up period was 29.8 months. In all, 7 patients (33%) had a recurrence at the time of surgery; 5 patients (24%) had already undergone pre-radiation. Furthermore, 18 patients (85.7%) received adjuvant radiotherapy. We found plate loosening or extrusion in 0 of 21 cases. A salivary fistula (4.7%) was observed in 1 patient. Trismus was found in 4 (19%) cases during follow-up. Osteoradionecrosis was found in 2 (9.5%) of 21 cases. Cosmetic deficits were not observed. CONCLUSION Our results show that the stair-step median mandibulotomy in combination with a 2.8 mm thick reconstruction plate and bicortical locking screws leads to a stable and safe reconstruction even with pre-irradiated situations. Plate loosening or extrusion did not occur.
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Affiliation(s)
- D Böger
- Klinik für Hals‑, Nasen- und Ohrenkrankheiten/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland.
| | - R Hartmann
- Klinik für Hals‑, Nasen- und Ohrenkrankheiten/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland
| | - M Sauer
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland
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Waltonen JD, Thomas SG, Russell GB, Sullivan CA. Oropharyngeal Carcinoma Treated with Surgery Alone: Outcomes and Predictors of Failure. Ann Otol Rhinol Laryngol 2021; 131:281-288. [PMID: 34056954 DOI: 10.1177/00034894211021287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the oncologic outcomes and risk factors for recurrence in patients who underwent surgery for oropharyngeal squamous cell carcinoma (OPSCC), and in whom adjuvant therapy was not recommended or was declined. METHODS Retrospective cohort study of patients with OPSCC who were treated with transoral surgery only at a tertiary care academic medical center from April 2010 to March 2019. RESULTS Seventy-four patients met inclusion criteria. In 16, adjuvant therapy was recommended but declined. There were 8 recurrences, of which 6 had been given recommendations for adjuvant therapy. Of the 8 recurrences, 2 died, 2 are alive with disease, and 4 were successfully salvaged. Five patients died of unrelated causes. Lymphovascular invasion (LVI, P = .016) had a significant impact on recurrence, while other pathologic features of the primary tumor such as size, location, human papillomavirus (HPV) status, and margin status did not. Margins were classified as "positive" in 4 patients, "close" in 54, and "negative" in 16. There were 3 local recurrences (4.1%), each of whom had declined adjuvant therapy. Lymph node features such as N-stage (P = .0004), number of positive nodes (P = .0005), and presence of extra-nodal extension (ENE, P = .0042) had a statistically significant impact on relapse. Smoking history and surgical approach showed no significant impact on recurrence. CONCLUSION Patients who undergo surgery for HPV-positive OPSCC with negative margins, no PNI, no LVI, and ≤1 positive lymph node without ENE have low risk for recurrence. These patients can likely be safely treated with surgery alone. Patients with these risk factors who decline adjuvant therapy are at risk for recurrence, and should be monitored.
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Affiliation(s)
- Joshua D Waltonen
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sydney G Thomas
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gregory B Russell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christopher A Sullivan
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Mandibular access osteotomy: Gate way to parapharyngeal space - A case report. Int J Surg Case Rep 2021; 80:105683. [PMID: 33639503 PMCID: PMC7921504 DOI: 10.1016/j.ijscr.2021.105683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/24/2022] Open
Abstract
Parapharyngeal space is an anatomically complex and difficult to access terrain for surgical interventions. Tumours originating from or extending into the parapharyngeal space are rare and literatures are suggestive of the occurrence of only 0.5% among all head and neck tumours. The aims of choosing the right approach should be complete removal of lesion, maintenance of occlusion and good temporomandibular function and preservation of inferior alveolar nerve. Performing the osteotomy anterior to mental foramen preserves the inferior alveolar nerve and the osteotomy between the teeth avoids the need of tooth removal. Out of the numerous techniques mandibular swing approach is a good option for skull base tumors because of the ease of technique even in inexperienced hands.
Introduction Para pharyngeal tumors often pose a challenge to surgeons for surgical interventions. Maxillofacial access osteotomies offer excellent visualization and permit unhindered surgical manipulation. Access osteotomy allows the surgeon an adequate access of the surgical field to resect the tumor completely and to preserve vital structures. Though numerous techniques exist, selection of the proper technique is the key factor in reestablishing the function and cosmesis. This article describes our experience with mandibular swing approach that has facilitated complete removal of a parapharyngeal space tumor. Case presentation 35years old female complained of deviation of tongue to one side and swallowing difficulty. Clinical and radiographic examinations were suggestive of a skull base lesion involving the hypoglossal nerve. After evaluation the tumor was excised through a mandibulotomy approach. Post operatively the patient was relieved completely of the symptoms and without any postoperative sequalae. Clinical discussion Accessibility is the main concern while dealing with skull base lesions. But the success of surgery lies on the selection of right approach. Paramedian mandibular swing approach has its own advantages over various other facial osteotomies. The swinging of the mandible gives advantage of accessing neck and skull base together, which is not possible with other facial osteotomies. Conclusion Management of skull base tumors involve a multidisciplinary approach. Choosing the right approach is often a major dilemma. Access osteotomies of facial skeleton is a hatchway to the skull base lesions. Of which mandibular swing approach is a good option for skull base tumors because of the ease of surgical technique even in inexperienced hands.
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Hamill CS, Maatouk CM, Clancy K, Zender CA, Rezaee RP. Cancellous Tibial Bone Graft for Malunion after Mandibular Reconstruction in Head and Neck Cancer. Laryngoscope 2020; 131:1291-1296. [PMID: 33264425 DOI: 10.1002/lary.29267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/03/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS While nonunion after mandibular reconstruction for head and neck surgery is rare, literature exploring management is scarce. Our primary objective was to determine success rates of tibial bone graft (TBG) in achieving mandibular union. Secondary objectives include determining factors that contribute to failure of TBG. STUDY DESIGN Retrospective Chart Review. METHODS Retrospective chart review between January 1, 2008 and December 31, 2018. Patients who underwent a mandibulotomy or mandibulectomy with osteocutaneous free flap reconstruction were identified. Patients who were pursuing dental rehabilitation, subsequently diagnosed with mandibular nonunion and received a cancellous TBG were assessed. RESULTS The 15 patients meeting inclusion criteria were mostly male (67%), white (87%), and nonsmokers (67%) with a median age of 64 (IQR = 60-73). Successful union occurred in 13 of 18 (72%) TBGs and the majority (63%) had a partial union documented at the time of surgery. Five patients (83%) who initially had a mandibulotomy achieved union compared to 78% of those with osteocutaneous reconstruction (P = 1.0). Postoperative radiation did not affect rates of union: 80% for both (P = 1.0). Patients with osteoradionecrosis (ORN) achieved union in 67% of cases compared to 75% of cases who did not have ORN (P = .86). There were similar rates of union for those who required perioperative antibiotics for infection and those without infection (67% vs. 75%, P = .86). Dental rehabilitation was achieved in 55% of patients, most commonly dentures. CONCLUSIONS This study shows that TBG can be used to achieve union for patients with malunion after head and neck cancer reconstruction. We show its successful use within the reconstructive algorithm for patients regardless of postoperative radiation for very small defects. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1291-1296, 2021.
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Affiliation(s)
- Chelsea S Hamill
- Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve, Cleveland, Ohio, U.S.A
| | | | - Kate Clancy
- Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve, Cleveland, Ohio, U.S.A
| | - Chad A Zender
- Department of Otolaryngology- Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Rod P Rezaee
- Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve, Cleveland, Ohio, U.S.A
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Chiu TH, Marchi F, Huang SF, Kang CJ, Liao CT, Hung SY, Cheong DCF, Tsao CK. Complication analysis of three different designs of temporary mandibulotomy in tongue cancer treatment. Head Neck 2020; 43:909-919. [PMID: 33289212 DOI: 10.1002/hed.26553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/13/2020] [Accepted: 11/10/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mandibulotomy helps access posterior oral cavity tumors. If osteotomy designs affect postoperative and postradiotherapy complications, needs to be tested clinically. METHODS Two hundred and eighteen patients who underwent midline mandibulotomy for primary tongue cancer wide excision and flap reconstruction at Chang Gung Memorial Hospital during 2014-2019. RESULTS There were 114 straight, 54 notched, and 50 stair-stepped osteotomy cases. Stair-stepped osteotomy had less advanced tumor stages (P = .009) and notched osteotomy more common single-plate fixations (P = .012). The former showed higher mandibular heights (P = .000) and more intact midline teeth (P = .011) than notched and straight ones. Straight osteotomy cases showed lower early infection rates (P = .039). Single-plate fixation was related to more flap dehiscence (P = .001) and oro-cutaneous fistulas (P = .035). CONCLUSIONS Complex osteotomy does not offer long-term benefits in midline mandibulotomies for primary tongue cancers and has higher early infections. Single-plate fixation increases postoperative complications.
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Affiliation(s)
- Ting-Han Chiu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Shao-Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - David Chon-Fok Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Carlwig K, Fransson P, Bengtsson M, Gebre-Medhin M, Sjövall J, Greiff L. Mandibulotomy access to tumour sites: fewer complications for postoperative compared with preoperative radiotherapy. Int J Oral Maxillofac Surg 2020; 50:851-856. [PMID: 33248870 DOI: 10.1016/j.ijom.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/09/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to compare complication rates at the mandibulotomy site between patients receiving preoperative radiotherapy (RT) and those receiving postoperative RT during treatment for oral and oropharyngeal cancer where the surgical procedure required a mandibular osteotomy to gain access to the tumour. Sixty-four consecutive patients treated during the period 2000-2015 were available for analysis. Their medical records were reviewed retrospectively. All patients were followed for at least 1year postoperatively. A subgroup of patients received RT on several occasions or long before the mandibulotomy, therefore the statistical comparisons focused on the two groups of patients receiving RT on one occasion and within 6 months prior to or following surgery. Seventeen patients presented a total of 29 complications, yielding an overall complication rate of 27%. Orocutaneous fistula was the most common complication. Patients who received RT preoperatively presented a higher complication rate (9/15; 60%) when compared to those who received RT postoperatively (2/31; 6.5%) (odds ratio 21.8, P<0.001). This study demonstrated fewer complications in the mandibulotomy area exposed to postoperative RT compared with preoperative RT. It is therefore suggested that, when possible, RT should be given postoperatively if combination treatment with RT and surgery, including a mandibulotomy, is planned.
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Affiliation(s)
- K Carlwig
- Department of ORL, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - P Fransson
- Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Oral and Maxillofacial Surgery, Skåne University Hospital, Lund, Sweden.
| | - M Bengtsson
- Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Oral and Maxillofacial Surgery, Skåne University Hospital, Lund, Sweden.
| | - M Gebre-Medhin
- Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Oncology, Skåne University Hospital, Lund, Sweden.
| | - J Sjövall
- Department of ORL, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - L Greiff
- Department of ORL, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
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George A, Shetty S, Subash A, Kudpaje A, Rao VUS. Modified compartmental resection-is mandibulotomy access justified? Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:139-140. [PMID: 33187939 DOI: 10.1016/j.oooo.2020.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Abhijith George
- Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, India
| | - Sameep Shetty
- Manipal college of Dental Sciences, Mangalore. A constituent of MAHE
| | - Anand Subash
- Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, India
| | - Akshay Kudpaje
- Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, India
| | - Vishal U S Rao
- Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, India
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The impact of lip-split mandibulotomy on patients treated for pT2 oral tongue squamous cell carcinoma: a study of 224 patients. Oral Maxillofac Surg 2020; 25:313-318. [PMID: 33141300 DOI: 10.1007/s10006-020-00918-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Head and neck surgeons often face a challenge in order to achieve adequate three-dimensional resection of tumours in the oral cavity, especially in the dentate patient. METHODS We compared the outcomes of lip-split mandibulotomy and trans-oral access, respectively, in patients treated for primary pT2 oral tongue SCC with regard to the status of the resection margins and the incidence of tumour recurrence. RESULTS Multivariate analysis showed a non-significant effect of the surgical technique used to the reported recurrence, F(1, 224) = 0.350, p = .555 and a significant effect on the margins achieved F(1, 224) = 11.381, p = .001. CONCLUSIONS Defects after excision of larger and more posterior tumours that are going to be reconstructed with free flaps represent a more probable indication for using an osteotomy access technique. Lip-split mandibulotomy is a low-morbidity technique which can deliver a sound oncological outcome and can be relatively easily taught to less experienced surgeons.
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Liu CJ, Fang KH, Chang CC, Lin ET, Chang GH, Shen JH, Chen YT, Tsai YT. Application of "parachute" technique for free flap reconstruction in advanced tongue cancer after ablation without lip-jaw splitting: A retrospective case study. Medicine (Baltimore) 2019; 98:e16728. [PMID: 31415367 PMCID: PMC6831483 DOI: 10.1097/md.0000000000016728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The hemi or subtotal/total glossectomy is usually approached by lip-jaw splitting procedure for advanced tongue cancer ablation. This highly invasive procedure can cause facial disfiguration, bone malunion, and osteoradionecrosis. The aim of this study is to compare the surgical outcome in free flap tongue reconstruction between novel parachute technique in an intact jaw and the conventional lip-jaw splitting procedure after tongue cancer ablation.In this study, parachute technique was adopted for free flap inset in patients without mandibulotomy. We retrospectively reviewed patients who have received primary advanced tongue cancer resection and free flap reconstruction during April, 2008 to January, 2015. Patients were divided into 2 groups. Group A was undergoing parachute technique without lip-jaw splitting. We sutured all the strings through the edges of defect in the first step and through the matching points of flap margin in the second step from outside the oral cavity. Then, the strings were pulled and the flap was parachuted down on the defects after all the matching points were tied together. In group B, the patients received conventional lip-jaw splitting procedure. Student t test was used for results analysis.There were 15 patients (n = 15) in group A and 15 patients (n = 15) in group B. In the patients receiving parachute technique, operation time showed 34 minutes (P = .49) shorter, hospital stay showed 4 days (P = .32) shorter, and the infection rate of surgical site showed 6.6% (P = .64) less than with conventional technique. The survival rates of the flaps were both 100% without revision.The parachute technique is an effective and more accessible method for free flap setting in cases of tongue reconstruction without lip-jaw splitting, and provides patients with better aesthetic appearance.
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Affiliation(s)
- Chin-Jui Liu
- Department of Otolaryngology, An-Nan Hospital, China Medical University, Tainan
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Ku-Hao Fang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan
| | - Chang-Cheng Chang
- School of Medicine, College of Medicine, China Medical University
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung
| | - Erh-Ti Lin
- School of Medicine, College of Medicine, China Medical University
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Jen-Hsiang Shen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan
| | - Yu-Tsung Chen
- Department of Dermatology, Shuang Ho Hospital, Taipei, Taiwan (R.O.C.)
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi
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Reconstructive Ladder for Transoral Resections of Oropharyngeal Cancers. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Analysis of an in-house technique for temporary mandibulotomy and its impact on postoperative radiotherapy. Int J Oral Maxillofac Surg 2018; 48:468-474. [PMID: 30527675 DOI: 10.1016/j.ijom.2018.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/20/2018] [Accepted: 11/16/2018] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to describe a newly developed procedure for temporary mandibulotomy and subsequent osteosynthesis. Clinical outcomes were evaluated, including complications and the impact on postoperative treatment, particularly postoperative radiotherapy. Twenty-four patients underwent temporary mandibulotomies for the surgical resection of malignancies located in the posterior oral or oropharyngeal region. All were treated with postoperative radiotherapy. An angulated median mandibulotomy was followed by osteosynthesis with three anchor screws directed towards the inferior aspect of the mandible. Anchor screws are modified conventional lag screws that include an additional biconcave washer. This modification prevents the screw heads from cracking into the cancellous bone during tightening, improving their biomechanical qualities considerably. Insertion of screws at any angle to the bony surface therefore becomes possible, which is a precondition for this technique. Minor complications occurred in two patients in the early postoperative period. However, complications causing bony non-union, leading to postponed postoperative radiotherapy were not noted in this cohort.
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Nabil S, Nazimi A, Nordin R, Hariri F, Mohamad Yunus M, Zulkiflee A. Mandibulotomy: an analysis of its morbidities. Int J Oral Maxillofac Surg 2018; 47:1511-1518. [DOI: 10.1016/j.ijom.2018.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/10/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022]
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Abstract
Oral cancer therapy is associated with a multitude of head and neck sequelae that includes, but is not limited to, hyposalivation, increased risk for dental caries, osteoradionecrosis of the jaw, radiation fibrosis syndrome, mucositis, chemotherapy-induced neuropathy, dysgeusia, dysphagia, mucosal lesions, trismus, and infections. Preparing a comprehensive treatment plan for patients undergoing cancer therapy is essential to help minimize their risks for developing these oral and dental complications. In addition, dentists must take into account a patient's ongoing oncologic therapy for those patients who present to the dentist while concurrently receiving cancer treatment.
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Affiliation(s)
- Lauren E Levi
- Department of Dentistry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1187, New York, NY 10029, USA
| | - Rajesh V Lalla
- Department of Oral Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030-1605, USA.
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18
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Transoral robotic surgery-based therapy in patients with stage III-IV oropharyngeal squamous cell carcinoma. Oral Oncol 2017; 75:16-21. [DOI: 10.1016/j.oraloncology.2017.10.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/07/2017] [Accepted: 10/13/2017] [Indexed: 01/03/2023]
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19
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Al-Saleh MAQ, Punithakumar K, Lagravere M, Boulanger P, Jaremko JL, Wolfaardt J, Major PW, Seikaly H. Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy. J Otolaryngol Head Neck Surg 2017; 46:8. [PMID: 28129794 PMCID: PMC5273832 DOI: 10.1186/s40463-017-0184-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The midline and paramedian mandibulotomy are surgical procedures that divide the mandibular bone into two halves and disconnects the condylar heads of the TMJ from each other. This study aimed to prospectively evaluate the temporomandibular joint (TMJ) functional and morphological changes after mandibulotomy using a reconstructed 3D models of the TMJ. METHODS Sixteen adult patients diagnosed with oral and oropharyngeal tumors with planned surgical mandibulotomy (test group, 9 patients) or transoral (control group, seven patients) treatments were included in the study. MRI and CBCT images were obtained immediately preceeding surgery and 6-8 weeks after surgery. Using the MRI-CBCT registered images, TMJ tissues were segmented at the two occasions by the same operator and 3D models were reconstructed for morphological assessment. Changes across time were measured using the volume overlap and Hausdorff distance of the disc and condyle 3D models. Disc-condyle relationship was measured using point-based and color map analysis. To assess the early functional changes, the Jaw function limitation scale (JFLS) and the maximum mouth opening were measured. Two-sample Hotelling T2 t-test was performed to determine the significance of the morphological and clinical outcomes' differences between the two groups. RESULTS The two-sample Hotelling T2 t-test showed significant differences (T2 (df1,df2) = 0.97 (5,26), p <0.01) between the mean values of all outcomes among the 2 groups. The change in disc displacement was significantly different between the two groups (p <0.05). However, the condylar displacement was not significantly different between the two groups (p =0.3). The average of the JFLS score was five times larger after mandibulotomy, and was 2 times larger after transoral surgery (p < 0.01). Patients showed decrease in the average of the maximum interincisal mouth opening by 11 mm after mandibulotomy, and by 5.4 mm after transoral surgery. CONCLUSION The quantitative assessment of the TMJ showed minimal changes of the condylar position and variable degrees of articular disc displacement associated with the paramedian split mandibulotomy. As well, limited jaw functions and vertical mouth opening were noticed more in the mandibultomy group compared to the transoral group in 6- weeks after surgery.
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Affiliation(s)
- Mohammed A Q Al-Saleh
- Orthodontic Graduate Program, School of Dentistry, University of Alberta, 476 Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, T6G 1C9, Canada.
| | - Kumaradevan Punithakumar
- Servier Virtual Cardiac Centre, Mazankowski Alberta Heart Institute and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.,Department of Computing Science, Faculty of Science, University of Alberta, Athabasca Hall, Room 411, Edmonton, Alberta, T6G 2E8, Canada
| | - Manuel Lagravere
- Orthodontic Graduate Program, School of Dentistry, University of Alberta, 476 Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, T6G 1C9, Canada
| | - Pierre Boulanger
- Servier Virtual Cardiac Centre, Mazankowski Alberta Heart Institute and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.,Department of Computing Science, Faculty of Science, University of Alberta, Athabasca Hall, Room 411, Edmonton, Alberta, T6G 2E8, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, 2A2.41 WC Mackenzie Health Science Center, Edmonton, Alberta, T6G 2R7, Canada
| | - John Wolfaardt
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 16940-87 Avenue, Edmonton, Alberta, T5R 4H5, Canada
| | - Paul W Major
- Orthodontic Graduate Program, School of Dentistry, University of Alberta, 476 Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, T6G 1C9, Canada
| | - Hadi Seikaly
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 16940-87 Avenue, Edmonton, Alberta, T5R 4H5, Canada
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Pang P, Li RW, Shi JP, Xu ZF, Duan WY, Liu FY, Huang SH, Tan XX, Sun CF. A comparison of mandible preservation method and mandibulotomy approach in oral and oropharyngeal cancer: A meta-analysis. Oral Oncol 2016; 63:52-60. [DOI: 10.1016/j.oraloncology.2016.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/15/2016] [Accepted: 11/08/2016] [Indexed: 01/11/2023]
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21
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Rapidis AD, Dijkstra PU, Roodenburg JLN, Rodrigo JP, Rinaldo A, Strojan P, Takes RP, Ferlito A. Trismus in patients with head and neck cancer: etiopathogenesis, diagnosis and management. Clin Otolaryngol 2016; 40:516-26. [PMID: 26098612 DOI: 10.1111/coa.12488] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Trismus indicates severely restricted mouth opening of any aetiology. A mouth opening of 35 mm or less should be regarded as trismus. Aim of this study was to review the etiopathogenesis, incidence, treatment and prevention of trismus in patients with head and neck cancer. OBJECTIVE OF REVIEW Trismus is frequently seen in patients suffering from malignant tumours of the head and neck. The reported prevalence of trismus in those patients varies considerably in the literature and ranges from 0 to 100% depending on the tumour site and extension. Trismus may worsen or remain the same over time, or the symptoms may reduce, even in the absence of treatment. When a patient presents with trismus after tumour treatment, it is important to determine whether the trismus is the result of the treatment, or is the first sign of a recurrence. Restricted mouth opening may impede inspection of the oral cavity as needed for dental care, and particularly for oncologic follow-up. CONCLUSIONS Mouth opening after radiotherapy (RT) decreases on average by approximately 20% compared to mouth opening prior to RT. The prevalence of trismus increases with increasing doses of RT to mastication structures. The use of intensity-modulated RT seems to lower the percentage and severity of RT-induced trismus. Treatment of trismus can be conservative (with either medical or physical therapy) or surgical. Exercise therapy is the mainstay of treatment and exercise should start as soon as possible after treatment. The prevention of trismus, rather than its treatment, is the most important objective.
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Affiliation(s)
- A D Rapidis
- Department of Head and Neck Surgery, Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece
| | - P U Dijkstra
- Center for Rehabilitation & Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J L N Roodenburg
- Department of Oral and Maxillofacial Surgery, Section of Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - A Rinaldo
- University of Udine School of Medicine, Udine, Italy
| | - P Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - R P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Ferlito
- University of Udine School of Medicine, Udine, Italy
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Bengtsson M, Korduner M, Campbell V, Fransson P, Becktor J. Mandibular Access Osteotomy for Tumor Ablation: Could a More Tissue-Preserving Technique Affect Healing Outcome? J Oral Maxillofac Surg 2016; 74:2085-92. [DOI: 10.1016/j.joms.2016.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 11/28/2022]
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Slama K, Slouka D, Slipka J, Fischer S. Short-term postoperative distress associated with open vs. transoral robotic surgery (TORS) in patients with T1-T2 carcinomas of the tongue base and supraglottis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160:423-8. [DOI: 10.5507/bp.2016.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/08/2016] [Indexed: 11/23/2022] Open
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Saini AT, Parasher AK, Kass JI, Altman KW, Miles BA. Intraoral midline mandibulotomy improves laryngeal access for transoral resection of laryngeal cancer. Am J Otolaryngol 2016; 37:95-8. [PMID: 26954859 DOI: 10.1016/j.amjoto.2015.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
Intraoral midline mandibulotomy is a technique that can be used to increase exposure for transoral endoscopic laser microsurgery (TLS). We describe the case of a 51 year old male with persistent T1 glottic carcinoma. At initial diagnosis, he had been referred for curative radiotherapy as laryngeal access was not sufficient for TLS. For treatment of his recurrence, we describe the technique of performing a midline mandibular osteotomy to improve access to the larynx allowing for safe and effective transoral endoscopic laser microsurgery. Surgical access to the larynx was greatly improved, and we were able to perform TLS in a case that would have otherwise not been amenable to TLS. An intraoral midline mandibulotomy can improve access to the larynx and allow for successful transoral resection of laryngeal cancer in patients with otherwise inaccessible tumors.
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Davis L, Zeitouni A, Makhoul N, Steinmetz OK. Surgical Exposure to Control the Distal Internal Carotid Artery at the Base of the Skull during Carotid Aneurysm Repair. Ann Vasc Surg 2016; 34:268.e5-8. [PMID: 26902936 DOI: 10.1016/j.avsg.2015.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
Extracranial carotid artery aneurysms are rare. Treatment options for these lesions include endovascular interventions, such as coiling and stenting, or surgical reconstruction, such as resection and primary reanastomosis, or interposition bypass grafting. In this report, we describe the surgical technique used to perform surgical repair of an internal carotid artery aneurysm extending up to the base of the skull. Anterior exposure of the infratemporal fossa and distal control of the carotid artery at the level of the carotid canal was achieved through a transcervical approach, performing double mandibular osteotomies with superior reflection of the middle mandibular section.
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Affiliation(s)
- Laura Davis
- Division of Vascular Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada
| | - Nicholas Makhoul
- Department of Oromaxillofacial Surgery, McGill University, Montreal, Canada
| | - Oren K Steinmetz
- Division of Vascular Surgery, Department of Surgery, McGill University, Montreal, Canada.
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Steiner T, Raith S, Scherer E, Mücke T, Torsiglieri T, Rohleder N, Eder M, Grohmann I, Kesting M, Bier H, Wolff KD, Hölzle F. Which kind of frontal mandibulotomy is the smartest? A biomechanical study. J Craniomaxillofac Surg 2015; 43:199-203. [DOI: 10.1016/j.jcms.2014.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 10/25/2014] [Accepted: 11/06/2014] [Indexed: 01/24/2023] Open
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Sperry SM, O''Malley Jr. BW, Weinstein GS. The University of Pennsylvania Curriculum for Training Otorhinolaryngology Residents in Transoral Robotic Surgery. ORL J Otorhinolaryngol Relat Spec 2015; 76:342-52. [DOI: 10.1159/000369624] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022]
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Dediol E, Čvrljević I, Dobranić M, Uglešić V. Comparative study between lag screw and miniplate fixation for straight midline mandibular osteotomy. Int J Oral Maxillofac Surg 2014; 43:399-404. [DOI: 10.1016/j.ijom.2013.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 06/11/2013] [Accepted: 09/03/2013] [Indexed: 11/28/2022]
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29
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Iloreta AMC, Anderson K, Miles BA. Mandibular osteotomy for expanded transoral robotic surgery: A novel technique. Laryngoscope 2014; 124:1836-42. [DOI: 10.1002/lary.24579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/07/2013] [Accepted: 12/30/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Alfred Marc C. Iloreta
- Department of Otolaryngology Head and Neck Surgery; Mount Sinai School of Medicine; New York New York
| | | | - Brett A. Miles
- Department of Otolaryngology Head and Neck Surgery; Mount Sinai School of Medicine; New York New York
- Department of Oral and Maxillofacial Surgery; Mount Sinai School of Medicine; New York New York
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Loevner LA, Learned KO, Mohan S, O’Malley BW, Scanlon MH, Rassekh CH, Weinstein GS. Transoral Robotic Surgery in Head and Neck Cancer: What Radiologists Need to Know about the Cutting Edge. Radiographics 2013; 33:1759-79. [DOI: 10.1148/rg.336135518] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shinghal T, Bissada E, Chan HB, Wood RE, Atenafu EG, Brown DH, Gilbert RW, Gullane PJ, Irish JC, Waldron J, Goldstein DP. Medial mandibulotomies: is there sufficient space in the midline to allow a mandibulotomy without compromising the dentition? J Otolaryngol Head Neck Surg 2013; 42:32. [PMID: 23663661 PMCID: PMC3652788 DOI: 10.1186/1916-0216-42-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 04/28/2013] [Indexed: 11/10/2022] Open
Abstract
Objectives The objective of this study was to determine the frequency of complications in median and paramedian mandibulotomies. In addition, the interdental space in the median and paramedian region was calculated. Study design Retrospective study. Setting Tertiary care center. Methods A retrospective chart review was performed for all cases where a mandibulotomy was performed from 2002 to 2010. 117 charts (61 paramedian and 56 median) were identified. We included data on complications, which fell in the following 2 categories: plate and dental complications. For our second objective, we evaluated 40 different patients with base of tongue or tonsillar cancer treated with intensity modulated radiation therapy (IMRT). The interdental space between the lateral incisors and the canines was electronically calculated on the digital Panorex images. Main outcome measures Dental and plate complications were evaluated. We also assessed interdental space. Results Patient characteristics were not significantly different. The median group had significantly more dental complications (p=0.0375, RD=0.19 and 95% CI (0.0139-0.3661)). The paramedian group had significantly more plate complications (p=0.0375, RD=0.082 and 95% CI (0.0131-0.1508). The distance between the central incisors was significantly less than the distance between the lateral incisors and canines both at the crestal and apical levels (p=0.0086 and p<0.001). Conclusions There are significantly more dental complications in the median approach. There were significantly more plate complications in the paramedian group. In addition, there is significantly less space in the between the median region as compared to the paramedian region. This is the first study that documents the advantage of the paramedian approach for dental complications.
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Affiliation(s)
- Tulika Shinghal
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Wharton Head and Neck Program, University Health Network, Princess Margaret Hospital, University of Toronto, 610 University Ave 3-952, Toronto, ON M5G 2M9, Canada.
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Judson BL, Adam SI, Lowlicht R, Bulsara KR. Transcervical Double Mandibular Osteotomy Approach to the Infratemporal Fossa. World Neurosurg 2012; 78:715.e1-5. [DOI: 10.1016/j.wneu.2011.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 10/07/2011] [Accepted: 12/06/2011] [Indexed: 11/25/2022]
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Mini-invasive lateral oropharyngectomy for T3-T4a oropharyngeal cancer. Eur Arch Otorhinolaryngol 2012; 270:1419-25. [PMID: 22923167 DOI: 10.1007/s00405-012-2158-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 08/06/2012] [Indexed: 11/12/2022]
Abstract
Mandibular swing is the approach of choice for resection of advanced oropharyngeal carcinomas without bone involvement. This approach requires a mandibulotomy, which is associated with complications. A prospective outcome analysis was performed for 21 patients operated without mandibulotomy for T3-T4a oropharyngeal carcinoma. Tumour size was categorized as T3 in 14 patients (66.7 %) and as T4a (33.3 %) in 7 patients. Twelve patients were N0 (57.1 %), 2 (9.5 %) were N1, and 7 (33.3 %) were N2. Surgical margins were negative in 18 cases (85.7 %), positive in 1 (4.8 %), and close in 2 (9.5 %). Average hospital stay was 14.5 days (range 10-22). Adjuvant treatment (radiotherapy or concurrent chemoradiotherapy) was administered to all but three patients previously irradiated. In all cases radiotherapy started within 42 days of surgery. The 3-year overall survival was 85.7 %, and relapse-free survival was 71.4 %. Oropharyngectomy without mandibulotomy has the same indications as mandibular swing. It provides good access to achieve satisfactory clearance of tumours, sparing patients the morbidity associated with mandibulotomy.
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de Almeida JR, Genden EM. Robotic assisted reconstruction of the oropharynx. Curr Opin Otolaryngol Head Neck Surg 2012; 20:237-45. [DOI: 10.1097/moo.0b013e328354c24e] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ketola-Kinnula T, Suuronen R, Kontio R, Laine P, Lindqvist C. Bioabsorbable Plates and Screws for Fixation of Mandibulotomies in Ablative Oral Cancer Surgery. J Oral Maxillofac Surg 2010; 68:1753-62. [DOI: 10.1016/j.joms.2009.07.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 05/06/2009] [Accepted: 07/31/2009] [Indexed: 11/25/2022]
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Peterson DE, Doerr W, Hovan A, Pinto A, Saunders D, Elting LS, Spijkervet FKL, Brennan MT. Osteoradionecrosis in cancer patients: the evidence base for treatment-dependent frequency, current management strategies, and future studies. Support Care Cancer 2010; 18:1089-98. [DOI: 10.1007/s00520-010-0898-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 04/26/2010] [Indexed: 10/19/2022]
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37
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A systematic review of trismus induced by cancer therapies in head and neck cancer patients. Support Care Cancer 2010; 18:1033-8. [DOI: 10.1007/s00520-010-0847-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
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Taub D, Tursun R, Gold L, Jamal BT. Nonunion of mandibular midline osteotomy after tumor surgery and radiation repaired by endosseous implants. J Oral Maxillofac Surg 2010; 68:833-6. [PMID: 20044192 DOI: 10.1016/j.joms.2009.07.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 07/22/2009] [Accepted: 07/26/2009] [Indexed: 11/24/2022]
Abstract
Nonunion of the mandible after microvascular flap reconstruction of defects resulting from tumor surgery is a known but rare complication, occurring in 5% of cases. When nonunion results with the use of microvascular flaps, rigid internal fixation, and radiotherapy, other options to treat the nonunion carry a greater risk of osteomyelitis, osteoradionecrosis, and/or persistent nonunion. Although endosseous implants have been reported to cause mandibular fracture in some cases, our case proposes and supports the use of implants for immobilization and/or prevention of nonunion of the mandible in patients who have a high probability of this complication developing, thereby avoiding plating across the nonunion site with the risk of plate exposure and osteoradionecrosis. This technique permitted a good quality of life in our patient during the healing period. He was able to masticate and phonate properly when compared with other treatment options that would have required external and/or intermaxillary fixation devices.
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Affiliation(s)
- Daniel Taub
- Oral and Maxillofacial Surgery Department, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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Dziegielewski PT, Mlynarek AM, Dimitry J, Harris JR, Seikaly H. The mandibulotomy: Friend or foe? Safety outcomes and literature review. Laryngoscope 2009; 119:2369-75. [DOI: 10.1002/lary.20694] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Čoček A, Průcha I, Hahn A. Lateral pharyngotomy extended by resection of the mandibular angle-an alternative approach to the surgical treatment of oropharyngeal (tonsillar) cancers. Acta Otolaryngol 2009; 129:318-23. [PMID: 18607919 DOI: 10.1080/00016480802165759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION The authors found the procedure, when used with the proper indications, to be an uncomplicated and expeditious method that presents little risk to surrounding structures, has no residual cosmetic or functional consequences for the patient, presents a low risk of complications, and has a good oncological outcome. The main indications for this procedure are related to the extent of the tumour and the surgeon's experience with the method. OBJECTIVES This study assessed the radical extent of each surgery, which was determined histopathologically, local and general complications to determine the safety of the procedure, and oncological and post-operative efficacy. METHOD In the 1970s, Tichy described, in Czech literature, an approach to treating oropharyngeal tumours through a lateral pharyngotomy with the approach extended by resection of the mandibular angle. From 2000 to 2006 the authors use this method to treat 63 patients having oropharyngeal cancer in various stages (T1 19%, T2 46%, T3 14%, T4 21%). RESULTS Microscopically, the operation was non-radical in three cases (4.8%). Of the local complications encountered, pharyngocutaneous fistulas were the most frequent, three cases (4.8%), and postoperative bleeding was seen in two cases (3.2%). General complications were seen in four cases (6.4%).
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Kolokythas A, Eisele DW, El-Sayed I, Schmidt BL. Mandibular osteotomies for access to select parapharyngeal space neoplasms. Head Neck 2009; 31:102-10. [DOI: 10.1002/hed.20934] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Basterra J, Bagán JV, Alba JR, Frías S, Zapater E. Oropharyngectomy without mandibulotomy in advanced stage (T3-T4) oropharyngeal cancer. Acta Otolaryngol 2007; 127:874-9. [PMID: 17763001 DOI: 10.1080/00016480601075373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSIONS The postoperative course was excellent for this type of surgery, and the functional recovery was comparable to that obtained with much more laborious techniques. OBJECTIVES To compare the advantages and disadvantages of the described technique and oropharyngectomy with labial mandibulotomy. PATIENTS AND METHODS A total of 46 patients underwent surgery by means of an oropharyngectomy without mandibulotomy. The pharynx was reconstructed using a plasty made of four regional flaps. RESULTS In addition to obvious esthetic benefits, complications of the osteotomy were absent and surgical time was reduced. Some patients undergoing pull-through oropharyngectomy also underwent a marginal mandibulectomy, markedly reducing the frequency of radionecrosis compared with other statistics of techniques using mandibulotomy.
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Affiliation(s)
- J Basterra
- Department of Otolaryngology and Head and Neck Surgery, Valencia University Hospital, and Valencia Medical School, Surgical Department, Valencia, Spain.
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Kim Y, Smith J, Sercarz JA, Head C, Abemayor E, Blackwell KE. Fixation of mandibular osteotomies: Comparison of locking and nonlocking hardware. Head Neck 2007; 29:453-7. [PMID: 17252590 DOI: 10.1002/hed.20541] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND : The outcome of patients undergoing rigid plate fixation of symphyseal mandibular osteotomies for exposure, resection, and reconstruction of tumors in the oral cavity or oropharynx was analyzed to determine the impact of hardware selection on complications. METHODS : Forty-five patients underwent titanium plate rigid internal fixation of mandibular osteotomies during cancer resection and free flap reconstruction at an academic medical center. The incidence of hardware-related complications and mandibular nonunion was compared in patients receiving either locking hardware or nonlocking hardware. RESULTS : The incidence of osteotomy-related complications in patients with an inferior border nonlocking mandibular fracture plate was 21%. In the patients with locking hardware or an inferior border nonlocking mandibular fracture plate combined with a tension band, there were no hardware-related complications and no mandibular nonunions. This difference was statistically significant (chi(2) = 6.01, p < .05). CONCLUSIONS : Locking mandibular reconstruction plates are associated with fewer complications than inferior border nonlocking mandibular fracture plates for rigid fixation of mandibular osteotomies in patients undergoing resection of head and neck cancer.
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Affiliation(s)
- Young Kim
- Division of Head and Neck Surgery, Department of Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
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Shohat I, Yahalom R, Bedrin L, Taicher S, Talmi YP. Midline versus paramidline mandibulotomy: A radiological study. Int J Oral Maxillofac Surg 2005; 34:639-41. [PMID: 15869865 DOI: 10.1016/j.ijom.2005.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Revised: 03/01/2005] [Accepted: 03/04/2005] [Indexed: 11/27/2022]
Abstract
Mandibulotomy allows for wide exposure of deep oral cavity and oropharyngeal tumors and may be performed medial or lateral to the mental foramen. Medial mandibulotomy is divided into midline and paramidline. Midline mandibulotomy requires detachment of muscles which may lead to masticatory and swallowing problems and could potentially jeopardize the central incisors. Our study provides a basis for placement of bone cuts in mandibulotomy. The angles between the long axis of the two central incisors, the lateral incisor and canine bilaterally were measured in panoramic radiographs of 100 healthy patients. The distances between the roots were measured. The angle between the lateral incisor and the canine ranged from 1 degrees to 8 degrees compared to 1 degrees -4 degrees (P<0.001) between the central incisors. The distances between the lateral incisor and the canine were 1-6.2mm while the distances between the two central incisors ranged from 0.5 to 4.7mm (P<0.05). Although the measurements were taken from a younger group of patients compared to the usual age of presentation of oropharyngeal cancer, it shows that the paramidline mandibulotomy in which bony cuts are performed through a wider gap is the preferred approach.
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Affiliation(s)
- I Shohat
- Department of Oral and Maxillofacial Surgery, The Chaim Sheba Medical Center and The Tel Aviv University School of Dentistry, Israel
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Pan WL, Hao SP, Lin YS, Chang KP, Su JL. The anatomical basis for mandibulotomy: midline versus paramidline. Laryngoscope 2003; 113:377-80. [PMID: 12567099 DOI: 10.1097/00005537-200302000-00032] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide an anatomical basis for mandibulotomy. STUDY DESIGN Prospective. METHODS The angles between the long axis of the two mandibular central incisors and between the lateral incisor and canine and the corresponding root length were measured in panoramic films of 50 Taiwanese patients who had oral or oropharyngeal carcinomas. RESULTS The angle and horizontal distance between the mandibular lateral incisor and canine were significantly wider than between the two central incisors. The root length of the canine measured 16 mm on average. CONCLUSIONS Paramidline mandibulotomy, which cuts through a wider space between the lateral incisor and canine, preserves dentition and the genioglossus and geniohyoid muscles. It appears to be a more preferable approach than midline mandibulotomy.
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Affiliation(s)
- Whei-Lin Pan
- Department of Dentistry, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
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Dai TS, Hao SP, Chang KP, Pan WL, Yeh HC, Tsang NM. Complications of mandibulotomy: midline versus paramidline. Otolaryngol Head Neck Surg 2003; 128:137-41. [PMID: 12574772 DOI: 10.1067/mhn.2003.28] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Mandibulotomy is an important surgical approach to oral cavity and oropharynx. The objective of this study was to evaluate the related complications of 2 common mandibulotomies: midline (osteotomy between 2 central incisors) and paramidline (osteotomy between lateral incisor and canine). STUDY DESIGN Ninety-six patients who had cancer in the oral cavity or oropharynx had preoperative evaluation of the mandible with panoramic films. Among them, 42 patients underwent mandibulotomies: midline for 19 patients and paramidline for 23. RESULTS Twenty (47.6%) of 42 patients had mandibulotomy-related complications, including 9 (21.4%) minor complications and 11 (26.2%) major complications. There were 6 (31.6%) major and 4 (21.1%) minor complications in the midline mandibulotomy and both 5 (21.7%) major and minor complications in the paramidline mandibulotomy. CONCLUSION There was no significant difference in the mandibulotomy-related complication rate between midline and paramidline mandibulotomies. Paramidline mandibulotomy, which preserves the geniohyoid and genioglossus muscles, should be a better function-preserving operation than midline mandibulotomy.
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Affiliation(s)
- Tsung-Sung Dai
- Department of Otolaryngology, Head and Neck Oncology (II), Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
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