The mandibulotomy: Friend or foe? Safety outcomes and literature review
✍ Scribed by Peter T. Dziegielewski; Alex M. Mlynarek; John Dimitry; Jeffrey R. Harris; Hadi Seikaly
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 219 KB
- Volume
- 119
- Category
- Article
- ISSN
- 0023-852X
No coin nor oath required. For personal study only.
✦ Synopsis
Abstract
Objective/Hypothesis:
To determine the safety outcomes of a unique mandibulotomy technique and to compare results to the world literature.
Study Design:
Retrospective review of a tertiary care head and neck cancer practice.
Methods:
A total of 220 consecutive lip‐splitting mandibulotomy access cases from 1998 to 2006 were identified in the University of Alberta's prospective head and neck surgery database and reviewed with follow‐up to June 2009. Uniform surgical technique consisting of a lower lip‐splitting incision, incisor extraction, a paramedian stair‐step osteotomy, and combination fixation with direct interosseous wires and a compression miniplate was utilized for all cases. Variations from traditional methods include adapting the compression miniplate to the reapproximated, rather than precut, mandible and utilizing a mentalis‐wire tacking stitch. The main outcome was the complication rate. Complications were recorded and separated into categories consisting of 1) fixation failure: malunion, nonunion, mandibular fracture, plate failure, wire protrusion; and 2) poor wound healing: hardware exposure, orocutaneous fistulae, osteomyelitis, and osteoradionecrosis.
Results:
Twenty‐three (10.5%) mandibulotomy‐related complications occurred in 22 (10.0%) patients. Six (2.7%) cases of fixation failure and 17 (7.7%) cases of poor wound healing were identified. The most common complication was hardware exposure. Uni‐ and multivariate regression analysis failed to show that any patient, tumor, or perioperative variables were statistically significant predictors of complications. Kaplan‐Meier analysis showed complications rates of 5.1% at 6 months, 7.0% at 12 months, and 10.2% at 24 months.
Conclusions:
The lip‐splitting mandibulotomy technique employed provides a safe and effective means of accessing difficult to reach anatomy of the upper aerodigestive tract. Laryngoscope, 2009