Malignancies of the oral cavity and oropharynx are typically treated with a combination of tumour ablative surgery and radiotherapy. Adequate exposure and access are essential to ensure precise tumour removal. However, achieving sufficient resection margins while minimising postoperative morbidity is a considerable challenge.
Mandibulotomy is an access osteotomy technique commonly performed as part of the surgical procedure to facilitate access for tumours of the floor of mouth, base of tongue and oropharynx. While mandibulotomy improves intraoperative exposure for both resection and reconstruction, it is associated with several complications including loss of or devitalisation of teeth, mal-union, infection, nerve damage, orocutaneous fistulae and plate exposure/fracture. In the situation where adjuvant radiotherapy is required the mandibulotomy site is at higher risk of osteoradionecrosis
While complications following mandibulotomy are not infrequent, several factors have been reported to reduce the likelihood of such undesirable outcomes, including osteotomy design, site of osteotomy and method of fixation.
We report a series of seven patients who received surgery as part of their treatment for oral cancer, each of whom experienced various complications following mandibular osteotomy procedures. In the discussion, we aim to highlight some technical areas which would reduce postoperative morbidity.
Brian Maloney 1,2 , Grace Kelly 1 , Osama Omer 1 , Dermot Pierse 2
1 Department of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Dublin
2 Department of Oral Surgery, Oral Medicine and Oral Pathology, Dublin Dental University Hospital,
Dublin