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The lip-splitting mandibulotomy: aesthetic and functional outcomes
Peter T Dziegielewski1, Daniel A O'Connell, Jana Rieger
1Division of Otolaryngology - Head and Neck Surgery, 1E4 University of Alberta Hospital, 8440-112 Street NW, Edmonton, Alberta, Canada T6G 2B7.
The lip-splitting mandibulotomy approach (LSMA) offers satisfactory cosmetic and functional outcomes for oral cancer patients, comparable to the trans-oral approach (TOA). Patients reported high satisfaction and low disfigurement perception with LSMA, with no significant impact on lip function or oral continence.
Area of Science:
- Head and Neck Surgery
- Oral Oncology
- Plastic and Reconstructive Surgery
Background:
- Oral and oropharyngeal cancers require surgical intervention, with varying degrees of invasiveness.
- The lip-splitting mandibulotomy approach (LSMA) is a highly invasive technique, while the trans-oral approach (TOA) is less invasive.
- Assessing aesthetic and functional outcomes is crucial for patient quality of life after these procedures.
Purpose of the Study:
- To compare the aesthetic and functional outcomes of the lip-splitting mandibulotomy approach (LSMA) versus the trans-oral approach (TOA) for oral cavity/oropharyngeal lesions.
- To evaluate patient satisfaction, scar cosmesis, disfigurement perception, and functional deficits following these surgical techniques.
Main Methods:
- Retrospective paired-cohort study of 36 patients with oral/oropharyngeal cancers.
- Patients were matched for gender, age, and follow-up time, with half undergoing LSMA and half TOA.
- Outcomes assessed included patient satisfaction, clinician/observer ratings, Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), lower-lip sensation/movement, and oral continence.
Main Results:
- LSMA patients reported high satisfaction and low self-perceived disfigurement, with no significant differences compared to TOA.
- Objective scar assessments (VSS, POSAS) showed no significant differences between the LSMA and TOA groups.
- While naïve observers rated LSMA scars as more disfiguring (p=.03), functional outcomes (lip sensation, movement, oral continence) were comparable between both approaches.
Conclusions:
- The lip-splitting mandibulotomy approach (LSMA) yields satisfactory cosmetic results and low patient-reported disfigurement for oral cancer surgery.
- LSMA does not negatively impact lower-lip sensation, movement, or oral continence compared to the trans-oral approach (TOA).
- Despite higher disfigurement ratings by naïve observers, LSMA remains a viable option with good patient-reported outcomes.