Midline versus paramidline mandibulotomy: a radiological study

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.