Straight midline mandibulotomy: technique and results of treatment

Mandibulotomy is an important surgical approach to tumors of the oral cavity and oropharynx. However the approaches and complications associated with this procedure varies in many studies.

The objective of this study is to discuss the feasibility of the technique and to evaluate its advantage and related complications.

A prospective study of 23 consecutive patients undergoing planned straight midline mandibular osteotomies as part of the ablative surgery for intraoral carcinoma. Twelve patients had primary lesions affecting the anterior two-thirds of the tongue, four at floor of mouth, three at posterior two-thirds of the tongue, two at deep lobe of parotid, one at soft palate and one at tonsil. Thirteen cases had T3 tumours, seven had T2 lesions and three had T4 tumors. In 5 patients the mandibulotomy was combined with a marginal mandibulectomy. Nineteen patients received post-operative radiotherapy. Various flaps were used for reconstruction : Pectoralis major myocutaneous flap ( n=7 ) , tongue flap ( n=4 ) and radial forearm free vascular flap ( n=2 ) cases. Primary closure using remaining mucosa was achieved in 10 patients. Adequate margins were achieved in all patients as proved by histopathology.

Primary healing of the osteotomy was noted in all patients and 5 ( 21.7 % ) patients had mandibulotomyrelated complications. One patient has lost one of the incisors adjacent to the mandibulotomy site during the operation. Dental problems with resorption of the alveolar margin and loosening of the teeth adjacent to the osteotomy were observed in 3 patients, one of them had lost his teeth.

Straight midline mandibulotomy provides excellent exposure for oral and oropharyngeal tumours, it is an easy procedure with low complication rate. Key Words : Straight midline mandibulotomy - Mandibulotomy - Mandibular swing - Oral cavity and orophayngeal neoplasms - Rigid fixation.