[Conservative trans-mandibular lateral pharyngectomy. Functional results in a series of 38 patients]

The authors present their experience with conservative transmandibular lateral pharyngectomy used for access to oropharyngeal tumours of the buccal cavity. This study was conducted to evaluate both early results and later aesthetic and functional sequelae after a simplified operation using mini-plaques. This surgical route was used for 38 patients since 1985, including 9 for salvage operations. Surgical indications were tumours of the posterior wall of the pharynx (28), the posterior part of the tongue (8), the retromolar tigone (1), the intramaxillary commissure (2) and the pelvi-lingual region (2). Access via the mandibulotomy was always evaluated peroperatively on the basis of the cleavability of the periosteum of the medial mandibular table. Immediate follow-up was uneventful in 74% cases. Post-operative complications included two general decompensations due to the original lesion, four minor local complications (spontaneous by regressive non-unions) and four local complications requiring a second intervention (flap necrosis, 2; orostomy, 2). Five of the complications were directly related to the mandibulotomy, giving an overall rate of 13%; the rates for first intention and salvage surgery were 9% and 18% respectively. Functional capacity was considered excellent in 75% of the cases and the aesthetic results were good in 94%. The satisfactory post-operative course, the low rate of major complications both after first intention and salvage surgery, and the excellent functional and aesthetic results suggest that transmandibular bucco-pharyngectomy should be preferred whenever the state of the cancerous lesion does not require exeresis of the ramus.