title: Mandibular osteotomy for expanded transoral robotic surgery: a novel technique.
abstract: OBJECTIVE
  Transoral Robotic Surgery (TORS) has revolutionized the surgical treatment of malignant lesions of the oropharyngeal region. Recent studies have shown that this approach is a very safe procedure and can provide favorable clinical and functional outcomes with respect to traditional approaches. However, a small minority of patients who present with lesions amenable to TORS resection may not be candidates due to anatomical access issues. Anatomic features such as a retrognathic mandible, macroglossia, trismus, dentition, and small oral aperture limit the ability to perform TORS with current technology. We propose a modified TORS approach in which transoral mandibular osteotomies are performed that can greatly improve exposure to oropharyngeal subsites and expand access to the larynx in selected patients.
  
  
  METHODS
  Five experimental procedures were performed on five cadavers.
  
  
  METHODS
  Five cadavers were obtained for the investigation. Measurements including retractor opening, lateral cephalography, acoustic pharyngometry, and high-resolution photographs were taken prior to mandibular osteotomies and then repeated following the osteotomies.
  
  
  RESULTS
  An increase in retractor opening, transoral exposure, and oral cavity was observed in all specimens.
  
  
  CONCLUSIONS
  Mandibular osteotomies increase exposure to oral cavity and oropharyngeal lesions in the setting of TORS.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York.
authors.forename: Alfred Marc C
authors.initials: AM
authors.lastname: Iloreta
authors.forename: Katie
authors.initials: K
authors.lastname: Anderson
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D063168:Mandibular Osteotomy / Q000379:methods*; D008875:Middle Aged; D009055:Mouth; D012371:Robotics / Q000379:methods*
keywords: HPV related oropharyngeal cancer; Transoral Robotic Surgery; osteotomy; squamous cell carcinoma