Transmandibular Approach in Head and Neck Oncological Surgery

Area of Science:

• Head and Neck Surgery
• Oral and Maxillofacial Surgery
• Surgical Oncology

Background:

• Surgical access to deep head and neck regions, including the oropharynx and hypopharynx, presents significant challenges.
• The transmandibular approach, utilizing lip-split mandibulotomy, has been employed for accessing complex malignant tumors.

Purpose of the Study:

• To evaluate the advantages and disadvantages of the transmandibular approach for accessing posterior maxilla, oropharyngeal, and hypopharyngeal regions.
• To assess the efficacy and outcomes of this surgical technique in head and neck cancer treatment.

Main Methods:

• Retrospective review of 42 patients undergoing lip-split mandibulotomy between 2008 and 2018.
• Analysis of diagnosis, surgical procedures, reconstruction methods, and complications for tumors in deep head and neck areas.

Main Results:

• The transmandibular approach was used for oropharyngeal tumors (54.76%), retromolar trigone (21.43%), and other deep head and neck sites.
• Forearm fasciocutaneous flaps (48.71%) and anterolateral thigh flaps (20.51%) were primary reconstruction methods.
• Surgical wound infection was the most frequent complication.

Conclusions:

• The transmandibular approach is a viable option for resecting complex oropharyngeal tumors, offering excellent visualization and bleeding control.
• It facilitates wide tumor margins and simplifies primary reconstruction.
• While transoral robotic surgery may advance, the transmandibular approach remains a valuable technique for deep oral cavity and oropharyngeal tumors.