Outcome Evaluation of Mandibular Pull-Through Approach for Glossectomies

Area of Science:

• Surgical Oncology
• Head and Neck Cancer Research
• Oral Cancer Treatment

Background:

• Advanced tongue carcinoma in the Indian subcontinent is often complicated by submucosal fibrosis (SMF) due to betel quid chewing.
• Effective surgical techniques are crucial for managing these complex cases, balancing tumor resection with functional preservation.

Purpose of the Study:

• To evaluate the functional and survival outcomes of the mandibular pull-through approach for total or near-total glossectomy in patients with advanced tongue carcinoma.
• To compare the efficacy of the mandibular pull-through approach with the traditional mandibular lip-split surgery in the Indian context.

Main Methods:

• A prospective study of 77 patients with advanced tongue carcinoma who underwent total or near-total glossectomy via the mandibular pull-through approach.
• Surgical assessment included operative time, margin status, reconstruction methods (PMMC, FRAFF, ALT flaps), and postoperative complications.
• Functional outcomes (decannulation, discharge, NG tube removal, speech) and survival outcomes (recurrence rates) were evaluated retrospectively.

Main Results:

• The mandibular pull-through approach demonstrated short operative times (≤30 min in 79%), clear margins (>5 mm in 90%), and manageable complication rates (e.g., surgical site infection 6.5%, partial flap loss 7.8%).
• High rates of decannulation (94%), discharge (92%), and successful NG tube removal (89% within 21 POD) were observed.
• Good speech outcomes were achieved in 52% of patients, with low long-term recurrence rates (9% local, 11% regional).

Conclusions:

• The mandibular pull-through approach provides excellent tumor accessibility with minimal mutilation, shorter operation times, and fewer postoperative complications.
• This technique offers better aesthetics and functional results compared to mandibular lip-split surgery for advanced tongue cancers, particularly in patients with SMF.
• The mandibular pull-through approach is a superior surgical option for advanced tongue and floor of mouth cancers in the Indian population, especially when combined with SMF management.