Clinical Evaluation between Mandibulotomy and Mandible Sparing Approaches in Oropharyngeal Cancer Operation and Reconstruction.

Kim, Jeong Tae; Lee, Jung Woo; Jo, Dong In; Lee, Hae Min

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2008;35(2):152-158.
Published online March 1, 2008.

Clinical Evaluation between Mandibulotomy and Mandible Sparing Approaches in Oropharyngeal Cancer Operation and Reconstruction.

Jeong Tae Kim, Jung Woo Lee, Dong In Jo, Hae Min Lee

Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea. jtkim@hanyang.ac.kr

Abstract

PURPOSE
Mandibulotomy approach and mandible sparing approach are most common methods for oropharyngeal cancer surgery. Good surgical view and convenience of flap inset are advantages of mandibulotomy approach but deformity of mandible contour, postoperative malocclusion and radionecrosis are its limitations. To make up for the limitations, mandible sparing method is commonly performed, but limited surgical view and difficulties of flap inset are the weak points of this approach. The purpose of the study is to compare mandibulotomy and mandible sparing approaches in postoperative complications and progression of the treatment in oropharyngeal cancer operation and reconstruction. METHODS: Single reconstructive microsurgeon operated for oropharyngeal cancer patients with different surgeons of head and neck department who prefer mandibulotomy and mandible sparing approach respectively, and we compared the frequency of postoperative complication, operation time, duration of hospitalization and recurrence rate between two different surgical approaches.
RESULTS
Mandibulotomy approach was used in 18 patients and mandible sparing approach was used in 15 patients. In mandibulotomy approach, there happened one case of teeth injury and one case of necrosis of skin and gingiva, but there happened no malocclusion and radionecrosis. In mandible sparing approach, there were 3 cases of fistula and 2 cases of infection which are significantly higher than mandibulotomy approach. There were no significant differences between early regional recurrence and duration of hospitalization.
CONCLUSION
In this study we compared two different methods for the surgical approach in oropharyngeal cancer surgery. As mandible sparing approach has difficulties of limited surgical view, it can be used for the limited indications of anterior tongue and mouth floor cancer. Mandibulotomy approach has advantages of good surgical view and convenience of flap inset. In this method preservation of gingival tissue, watertight fashion suture, delicate osteotomy and plate fixation to maintain occlusion are the key points for the successful results.

Keywords: Approach for the oropharyngeal cancer; Mandibulotomy; Mandible sparing