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Technical note: Combined approach for total mandibulectomy
Mateo Castano Ospina1, Jane Pegg2, Sarah Boston1
1Capital City Specialty & Emergency Animal Hospital, Ottawa, Ontario, Canada.
Objective:
To describe a novel combined approach for total mandibulectomy (CATM) by combining a lateral approach for condylectomy and a ventral approach for total mandibulectomy.
Study Design:
Descriptive technical note utilizing a cadaveric study and clinical case.
Animals:
One dog cadaver (27 kg, mixed breed) and one clinical case (2.5-year-old castrated male Australian Shepherd).
Methods:
The CATM technique was evaluated in a dog cadaver prior to clinical application in a dog with a left mandibular soft tissue sarcoma. Condylectomy was performed by a lateral approach to the temporomandibular joint followed by a ventral paramedian approach for left total mandibulectomy.
Results:
CATM was successfully performed in both the cadaveric model and clinical case without intraoperative complications. Extending the lateral condylectomy incision caudally allowed for regional lymphadenectomy in the clinical case. Medial drift of the right mandible resulted in palatal contact trauma that was successfully managed with crown height reduction and vital pulpotomy. At two months postoperatively, the dog maintained good clinical function without tumor recurrence or additional adverse effects.
Conclusion:
The CATM was a feasible technique that provided increased TMJ exposure for joint disarticulation and condylectomy.
Clinical Significance:
The CATM provides a safe and effective technique for total mandibulectomy that optimizes TMJ access, facilitating joint disarticulation and condylectomy, while enhancing visualization of neurovascular structures.