The mandibulotomy: friend or foe? Safety outcomes and literature review.
OBJECTIVE
To determine the safety outcomes of a unique mandibulotomy technique and to compare results to the world literature.


METHODS
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.
Dziegielewski
Peter T
PT
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
Mlynarek
Alex M
AM
Dimitry
John
J
Harris
Jeffrey R
JR
Seikaly
Hadi
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery*; D008875:Middle Aged; D019647:Oral Surgical Procedures; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome