Median mandibulotomy: a critical assessment

Median mandibulotomy (mandibular "swing") has supplanted mandibular resection for access to oral and oropharyngeal tumors when there is intervening grossly normal tissue between the tumor and bone. It has also proved useful for exposure in selected patients with deep lobe parotid or parapharyngeal space tumors. We have reviewed our experience with 313 mandibulotomies performed between 1959 and 1988 with emphasis on indications, complications, and modifications in technique. Most of our mandibulotomy patients had an uncomplicated recovery, but osteotomy-related complications occurred in 20%. These complications were usually minor and no instances of nonunion were recorded. There was no apparent relationship to antecedent or postoperative radiotherapy. Dental splints were used only in selected patients (40%). The technique of osteotomy has been evolving in recent years. Paramedian, rather than median mandibulotomy, minimizes trauma to the genioglossus, geniohyoid, and digastric muscles. Miniplates offer a useful alternative to conventional wire fixation. Preoperative dental assessment has facilitated better occlusion postoperatively in dentulous patients.