Complications of Mandibulotomy: Midline Versus Paramidline

Abstract

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.

Swing Mandibulotomy Access to Deep Lobe Parotid Tumors Case Reviews

“…The authors had reviewed 313 mandibulotomies performed between 1959 and 1988 with emphasis on indications, complications, and modifications in technique. In a comparative study between these two types, Tsung SD et al [14] did not find any differences that were statistically significant. Amin MR et al [12], however, concluded straight midline osteotomy to be advantageous with no significant complications seen within 1-year follow-up.…”

“…The risk of malignant transformation seems to be higher in patients older than 40 years of age, men, and patients with solitary nodules over 2cms in diameter [8]. The risk of malignancy has, also, been linked to the frequency of recurrence [14,19]. An accurate diagnosis is essential for planning the best surgical approach to safely and radically remove PPS tumors Papadogeorgakis N et al [20] considered five main parameters in selecting the best approach in treating tumors of the PPS including the proximity and the projection of the tumor to the oropharyngeal wall or, the neck, the size of the tumor, the suspicion of malignancy, the vascularity and relation of the tumor to the neck neurovascular bundle.…”

“…In spite of rigid flxation, the bony gap remains, and mobility of unstable fragments increases the probability of post-operative complications such as malocclusion, non-union, and osteoradionecrosis following post-operative irradiation. Mandibulotomy is an important surgical approach for tumors in the oral cavity, oropharynx, parapharyngeal space, nasopharynx and skull base [14]. Based on these factors, mandibular swing approach has been considered to be an ideal technique to approach tumors in the pharyngeal and parapharyngeal space (PPS) region avoiding blind and unnecessary injuries (Han, et al 2002 andSun, et al 2006).…”

“…It is performed transorally, transcervically or, guided by USG or, CT and predicts the nature of the lesion which assists surgeonpatient planning. Management recommendations for recurrent tumors include observation, local or, extensive surgery, radiation therapy, or, a combination of these [9,[13][14][15][16]. Recurrences are often extensive and multifocal making the risk of facial nerve damage and chances of re-recurrence high [8,13,17].…”

Oral and maxillofacial surgery: challenges and changes

“…Functional and oncological outcomes have been good, and in carefully selected patients, TORS provides locoregional control in the confined surgical anatomy of the upper aerodigestive tract, without the morbidity of wide surgical access or speech and swallowing impairment that often accompanies high dose radiation 10,11 . Because most TORS defects result from early stage tumours and are consequently small, reconstructive efforts have often been limited to healing by secondary intention.…”