title: Combined transoral and suprahyoid approach for oropharyngeal cancers: an alternative to mandibulotomy.
abstract: Surgical treatment of oropharyngeal tumours usually requires mandibular osteotomy. Using this technique allows a better exposure and an easier excision, but this approach often generates complications. Since 1995, we used a less aggressive surgical technique, with a suprahyoid pharyngotomy when the oral approach was not sufficient, thus sparing the mandible.
  
  
  OBJECTIVE
  The purpose of this study is to evaluate this technical evolution, ensuring that mandibular preservation doesn't affect quality of exeresis, local control and survival, while allowing a lower complication rate.
  
  
  METHODS
  All patients who have had a surgical treatment for an oropharyngeal carcinoma between 1995 and 2001 in our center were included in this study.
  
  
  RESULTS
  Mandibular sparing was used for 55 patients; 19 patients underwent mandibulotomy. The surgical procedure's quality was classified as clear, close, or insufficient margins. All adjuvant treatments were noted, functional and carcinologic results were evaluated. No significant differences are found for exeresis quality and local control. There are less complications (p = 0.045) and less surgical revisions (p = 0.023) in the preservation group. Survival and functional results are better in the preservation group, but without significant difference. For oropharyngeal tumours, survival is dependent on tumoural aggressivity, on general condition and co-morbidity and on the development of a second tumour. Results in local control rate (83.7% at 1 year) are satisfying compared to literature.
  
  
  CONCLUSIONS
  Mandibular preservation is an efficient and safe procedure, even for T3/T4 tumours. Most of oropharyngeal tumours can be removed without mandibulotomy. The suprahyoid approach provides a good exposure when oral approach is insufficient, thus avoiding mandibulotomy and its complications.
authors.affiliation: Centre Alexis Vautrin, Unité de Chirurgie Cervico-Faciale, Département de Chirurgie Oncologique, Avenue de Bourgogne, Brabois, 54511 Vandoeuvre les Nancy cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Gallet
authors.forename: P
authors.initials: P
authors.lastname: Gangloff
authors.forename: R
authors.initials: R
authors.lastname: Mastronicola
authors.forename: S
authors.initials: S
authors.lastname: Cortese
authors.forename: B
authors.initials: B
authors.lastname: Phulpin
authors.forename: H
authors.initials: H
authors.lastname: Mecellem
authors.forename: M
authors.initials: M
authors.lastname: Kaminski
authors.forename: J
authors.initials: J
authors.lastname: Guillet
authors.forename: G
authors.initials: G
authors.lastname: Dolivet
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies