Critical aspects of the transmandibular approach to the oral cavity and oropharynx

Abstract

In the context of tumor surgery, the median mandibulotomy as an access route to the oral cavity and oropharynx provides an excellent overview of the surgical site. However, it is not regarded entirely unproblematic with regard to early and later complications that may arise. The results and complications of the median mandibulotomy will be presented based on data collected from our own patient collective. A total of 21patients who had undergone amedian mandibulotomy as part of tumor surgery at the Department of Otorhinolaryngology of the SRH Zentralklinikum Suhl were examined over aperiod from 01January2010 to 31December2020. The patient files were retrospectively evaluated. A stair-step median mandibulotomy was performed in all 21patients. Reconstruction was performed using a2.8 mm thick angled mandibular plate and bicortical locking screws. The mean follow-up period was 29.8months. In all, 7patients (33%) had arecurrence at the time of surgery; 5patients (24%) had already undergone pre-radiation. Furthermore, 18patients (85.7%) received adjuvant radiotherapy. We found plate loosening or extrusion in 0of 21cases. A salivary fistula (4.7%) was observed in 1patient. Trismus was found in4 (19%) cases during follow-up. Osteoradionecrosis was found in2 (9.5%) of 21cases. Cosmetic deficits were not observed. Our results show that the stair-step median mandibulotomy in combination with a2.8 mm thick reconstruction plate and bicortical locking screws leads to astable and safe reconstruction even with pre-irradiated situations. Plate loosening or extrusion did not occur.