Discussion

Abstract

In this study, Melugin et al have attempted to evaluate the effect of the size and shape of a rim mandibulectomy on residual mandibular strength and resistance to fracture. Their goal was to improve the use of the rim mandibulectomy technique, as well as to establish a threshold for the application of prophylactic internal fixation. In reviewing their study, it is clear that they have further enhanced our understanding of this procedure. I believe that they have provided further data that the curvilinear shape of the osteotomy is biomechanically more favorable than the right-angled osteotomy and is less likely to fracture when used in similar surgical settings. They also suggest in their analysis that fracture formation was relatively uniform, arising at the posterior aspect of the osteotomy, and that this should be taken into consideration when a surgeon is considering the application of prophylactic internal fixation. I believe that this is an important piece of data that has clinical significance. However, although I believe the study provides a suggestion as to when prophylactic internal fixation should be used, it does not answer this question completely.