Modified mandibulotomy technique to reduce postoperative complications: 5-year results

Abstract

Purpose: To review the 5-year outcomes of our modified mandibulotomy technique. Retrospective review of a tertiary level oral cancer center.

Materials and methods: During a 5-year period, 30 patients who had a uniform surgical technique consisting of a lower lip-splitting, modified stair-step osteotomy with thin saw blade and osteotome after plate-precontouring and combination fixation with monocortical osteosynthesis (miniplate) and bicortical osteosynthesis (maxiplate and bicortical screws), with at least 14 months postoperative follow-up, were selected and reviewed retrospectively.

Results: There were 8 women and 22 men with an average age of 56.5 years. All the patients involved malignancies were squamous cell carcinoma. The main primary sites of the those who underwent a mandibulotomy were the tonsil, the base of tongue, the oral tongue, the retromolar pad area, and others. Others included buccal cheek, floor of mouth, and soft palate. 23 patients received postoperative radiation therapy, and among whom 8 patients also received chemotherapy. Total four (13%) mandibulotomy-related complications occurred, only two (6.7%) requiring additional operation under general anesthesia.

Conclusion: Our modified mandibulotomy meets the criteria for an ideal mandibulotomy technique relatively well because it requires no intermaxillary fixation, can precise preserve the occlusion in a precise way, allows early function, requires no secondary procedures, and has few complications.

Keywords: Mandibulotomy; oropharyngeal cancer; stair-step mandibulotomy.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1

Schematic diagram of lingual osteotomy with an oscillating saw in the preconstruction phase of intentional fracture. Note that the osteotomy should be continued until the oscillating saw is as close to the outer surface of the lingual cortex as possible.

Fig. 2

Schematic diagram of bucco-lingual corticotomy. Note that the buccal corticotomy is completed with a saw and the lingual corticotomy with an osteotome following indentation of the lingual cortex with an oscillating saw. The inferior border of the mandible should be completely osteotomized to prevent undesirable splitting while malleting the osteotome due to the inferior border's thick cortex.

Fig. 3

Fixation using bicortical and monocortical plates and screws. Our modified technique does not require IMF or tooth extraction.