title: The lip-splitting mandibulotomy: aesthetic and functional outcomes.
abstract: To determine the aesthetic and functional outcomes of the most invasive approach to oral cavity/oropharyngeal lesions, the lip-splitting mandibulotomy approach (LSMA), versus the least invasive, the trans-oral approach (TOA). Retrospective paired-cohort study. Thirty-six patients with oral/oropharyngeal cancers treated with primary surgical extirpation, bilateral neck dissections and adjuvant radiation therapy were enrolled. Half underwent LSMA and half TOA. Patients were paired into gender, age and follow-up time matched cohorts. The primary outcome measure was overall patient satisfaction with scar cosmesis assessed with a 10-point Likert scale. Clinician and naïve viewer ratings of disfigurement in addition to the validated Vancouver scar scale (VSS) and patient and observer scar assessment scale (POSAS) were completed. Functional outcomes included lower-lip sensation and movement as well as oral continence assessment. LSMA patients had very high satisfaction and low perceptions of disfigurement with no statistically significant differences between cohorts (p>.05). VSS and POSAS results failed to demonstrate significant differences between groups (p>.05). Naïve observers, however, found the LSMA to be more disfiguring than TOA scars (p=.03). No significant differences in lower-lip sensation to touch, two-point discrimination or temperature distinction were found (p>.05). House-Brackman and movement symmetry scores were significantly indifferent between cohorts (p>.05). Video-fluoroscopic swallowing studies showed no difference in oral continence between cohorts (p>.05). The LSMA provides satisfactory scarring and low self-perception of disfigurement for patients. Moreover, the LSMA does not impact lower-lip sensation, movement or oral continence.
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, 1E4 University of Alberta Hospital, 8440-112 Street NW, Edmonton, Alberta, Canada T6G 2B7.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Dziegielewski
authors.forename: Daniel A
authors.initials: DA
authors.lastname: O'Connell
authors.forename: Jana
authors.initials: J
authors.lastname: Rieger
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Harris
authors.forename: Hadi
authors.initials: H
authors.lastname: Seikaly
mesh_terms: D000328:Adult; D000368:Aged; D002921:Cicatrix; D015331:Cohort Studies; D004954:Esthetics / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008488:Medical Illustration; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods*; D009959:Oropharyngeal Neoplasms / Q000601:surgery*; D017060:Patient Satisfaction; D010781:Photography; D011788:Quality of Life / Q000523:psychology*; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome