title: Medial mandibulotomies: is there sufficient space in the midline to allow a mandibulotomy without compromising the dentition?
abstract: OBJECTIVE
  The objective of this study was to determine the frequency of complications in median and paramedian mandibulotomies. In addition, the interdental space in the median and paramedian region was calculated.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  A retrospective chart review was performed for all cases where a mandibulotomy was performed from 2002 to 2010. 117 charts (61 paramedian and 56 median) were identified. We included data on complications, which fell in the following 2 categories: plate and dental complications. For our second objective, we evaluated 40 different patients with base of tongue or tonsillar cancer treated with intensity modulated radiation therapy (IMRT). The interdental space between the lateral incisors and the canines was electronically calculated on the digital Panorex images.
  
  
  METHODS
  Dental and plate complications were evaluated. We also assessed interdental space.
  
  
  RESULTS
  Patient characteristics were not significantly different. The median group had significantly more dental complications (p=0.0375, RD=0.19 and 95% CI (0.0139-0.3661)). The paramedian group had significantly more plate complications (p=0.0375, RD=0.082 and 95% CI (0.0131-0.1508). The distance between the central incisors was significantly less than the distance between the lateral incisors and canines both at the crestal and apical levels (p=0.0086 and p<0.001).
  
  
  CONCLUSIONS
  There are significantly more dental complications in the median approach. There were significantly more plate complications in the paramedian group. In addition, there is significantly less space in the between the median region as compared to the paramedian region. This is the first study that documents the advantage of the paramedian approach for dental complications.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Wharton Head and Neck Program, University Health Network, Princess Margaret Hospital, University of Toronto, 610 University Ave 3-952, Toronto, ON M5G 2M9, Canada. David.Goldstein@uhn.ca.
authors.forename: Tulika
authors.initials: T
authors.lastname: Shinghal
authors.forename: Eric
authors.initials: E
authors.lastname: Bissada
authors.forename: Hon Biu
authors.initials: HB
authors.lastname: Chan
authors.forename: Robert E
authors.initials: RE
authors.lastname: Wood
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.forename: Dale H
authors.initials: DH
authors.lastname: Brown
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Gilbert
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
authors.forename: John
authors.initials: J
authors.lastname: Waldron
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
mesh_terms: D000368:Aged; D003817:Dentition; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D010025:Osteoradionecrosis / Q000453:epidemiology; D011862:Radiography, Panoramic; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D014062:Tongue Neoplasms / Q000532:radiotherapy*; D014067:Tonsillar Neoplasms / Q000532:radiotherapy*