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Stair-stepped mandibulotomy: Clinical indication, surgery program design, and operation points.

Shuqi Zhao1, Zhengxue Han1, Yi Qu1

  • 1Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China, 100050.

Journal of Stomatology, Oral and Maxillofacial Surgery
|April 3, 2024
PubMed
Summary

Stair-stepped mandibulotomy offers a functional surgical approach for oral and oropharyngeal cancers. This technique preserves mandibular structure and function, minimizing damage to crucial muscles for improved patient outcomes.

Keywords:
Functional surgeryHead and neck cancerStair-stepped mandibulotomySurgical approach

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Area of Science:

  • Surgical Oncology
  • Oral and Maxillofacial Surgery
  • Otorhinolaryngology

Background:

  • Radical treatment of posterior oral cavity and oropharyngeal malignancies often necessitates mandibulotomy for tumor exposure.
  • Conventional midline or paramedian vertical mandibulotomies can compromise suprahyoid musculature and genioglossus function, impacting swallowing and speech.
  • There is a need for surgical techniques that balance adequate tumor resection with functional preservation.

Purpose of the Study:

  • To introduce and evaluate the stair-stepped mandibulotomy technique.
  • To describe the surgical program design, key operative steps, and functional outcomes of this novel approach.
  • To highlight the advantages and disadvantages of stair-stepped mandibulotomy in managing specific oropharyngeal tumors.

Main Methods:

  • The study presents a case report detailing the application of stair-stepped mandibulotomy in two patients.
  • The technique is based on functional surgery principles, aiming to preserve mandibular integrity and muscle attachments.
  • Surgical program design and specific operation points for the stair-stepped mandibulotomy were elaborated.

Main Results:

  • Stair-stepped mandibulotomy provides a clear surgical field for tumor resection in the posterior oral cavity and oropharynx.
  • The technique is designed to preserve the structure and function of the mandible and critical muscle attachments.
  • This approach is particularly suitable for tumors involving the middle/posterior tongue or oropharynx, including extrinsic tongue muscles.

Conclusions:

  • Stair-stepped mandibulotomy represents a promising functional surgical alternative for specific oropharyngeal and oral cavity malignancies.
  • The technique aims to optimize oncologic resection while minimizing functional deficits in swallowing and speech.
  • Further investigation and broader application are warranted to fully establish its role in head and neck cancer surgery.