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The mandibulotomy: Friend or foe? Safety outcomes and literature review

Authors

  • Peter T. Dziegielewski MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
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  • Alex M. Mlynarek MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
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  • John Dimitry MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
    2. Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Jeffrey R. Harris MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
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  • Hadi Seikaly MD

    Corresponding author
    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
    • 1E4.29 Walter C. Mackenzie Centre, 8440-112 Street NW, Edmonton, Alberta T6G 2B7, Canada
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  • Presented at the 7th International Conference on Head and Neck Cancer, San Francisco, California, U.S.A., July 20, 2008.

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

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