Contributing factors to mandibulotomy complications: a retrospective study.
OBJECTIVE
The purpose of this article is to investigate the complications associated with mandibulotomies and analyze contributing factors.


METHODS
A total of 103 patients, who had undergone a mandibulotomy for tumors of the oral cavity or oropharynx, were identified and their hospital records, clinical charts, and radiographs retrospectively reviewed. Variables associated with mandibulotomy complications (osteotomy type, osteotomy site, tooth extraction, fixation method, radiation, and chemotherapy) were classified and statistically analyzed.


RESULTS
Various complications were encountered in 19 (18.4%) patients, and were classified into 2 categories: intraoperative and postoperative complications. Paramedian (42.7%) stair-step (86.4%) osteotomies had been frequently used. Rigid fixation using one monocortical plate, one bicortical plate, and screws (MCP + BCP [46.6%]) was the main fixation method and showed statistical significance in the complications of mandibulotomy (P < .05). Five (71.4%) out of 7 patients who received preoperative radiotherapy developed postoperative complications, and 3 (60%) out of 5 patients who received preoperative chemotherapy developed complications. Among the complications, nonunion was observed in 7 (6.7%) patients and osteoradionecrosis in 5 (4.9%).


CONCLUSIONS
Paramedian stair-step osteotomy is recommended and the reapproximation is improved with minimal bone loss using a thin saw blade. Rigid monocortical and bicortical plate fixation (MCP + BCP) is advantageous to preventing postoperative complications. Perioperative radiation therapy contributes to those complications, therefore it is necessary to establish the precise position of the portals and the adequate dose of radiotherapy through consultation with a radiation oncologist preoperatively, and consider a proper surgical approach. Because infection is an important contributing factor, it is necessary to actively control the infection to decrease the incidence of complications.
Nam
Woong
W
Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea.
Kim
Hyung-Jun
HJ
Choi
Eun-Chang
EC
Kim
Moon-Key
MK
Lee
Eui-Wung
EW
Cha
In-Ho
IH
D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D019248:Jaw Fixation Techniques / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors