Approach to the Pterygomaxillary Space and Posterior Part of the Tongue by Lateral Stair-Step Mandibulotomy

Pinsolle, J; Siberchicot, F.; Emparanza, Angel; Caix, P.; Michelet, F X

doi:10.1001/archotol.1989.01860270055014

Cited by 21 publications

(16 citation statements)

References 5 publications

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“…Surgical access to the posterior oral cavity and oropharynx can be accomplished via a multitude of approaches, including pull‐through glossotomy, pharyngotomy, or mandibuectomy 7, 13. Unfortunately, these methods often provide inadequate lateral exposure and can have significant morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Osteotomy sites can be located anterior to the mental foramina, in the median7–13 or paramedian,1–3, 9–12 or posteriorly in the lateral mandible; however, the latter site has been plagued with complications and has largely been abandoned 14. Cut shape has been described as straight,15 dovetail,5 notched,1 and stair‐step 16.…”

Section: Discussionmentioning

confidence: 99%

“…Fixation devices include direct interosseous wires,1, 3, 16 K‐wires,17, 18 lag screws,19 monocortical and bicortical plates,3 compression miniplates,2, 7, 8, 10–12, 20, 21 dynamic compression plates,2, 17 and fixed mandibular implants 22. With endless combinations possible, little agreement exists as to which method provides optimal results 1–4, 7–14, 16, 19–22…”

Section: Discussionmentioning

confidence: 99%

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The mandibulotomy: Friend or foe? Safety outcomes and literature review

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The mandibulotomy: Friend or foe? Safety outcomes and literature review

et al. 2009

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“…The presumptious intent of trying to recreate the delicate periodontal tissues by means of a bulky skin fl ap could justify the elimination of teeth to ensure optimal soft-tissue healing. The use of a nasogastric feeding tube in the healing period is a good precaution to avoid contamination of the wound [5] , with clear liquids only orally for 3-4 weeks.…”

Section: Discussionmentioning

confidence: 99%

Mandibular Access Osteotomies in Oral Cancer

Støre¹,

Boysen²

2005

ORL

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Purpose: Mandibulotomy is a recognised surgical approach to tumours of the oral cavity and oropharynx. However, the nature and frequency of complications associated with this procedure varies in many studies. We report our experience with access osteotomies, with special reference to radionecrotic complications. Procedures: A retrospective study of 18 consecutive patients undergoing planned mandibular osteotomies as part of the ablative surgery was performed. Various flaps were used for tissue closure: myocutaneous flap (n = 8), nasolabial flap (n = 1) and radial forearm free vascular flap (n = 6). Primary closure using remaining mucosa was achieved in 3 patients. Results: Complete healing of the osteotomy was noted in 13 patients, and 5 patients (27%) developed major wound healing problems and osteoradionecrosis. Dental problems with resorption of the alveolar bone crest and loosening of the teeth adjacent to the osteotomy were seen in 7 patients (39%). Conclusions: Adequate soft-tissue closure is as important for a successful outcome as the type of osteotomy and fixation method applied. Extraction of the incisors is recommended for easier and safer tissue adaptation, especially when flaps are used for coverage and the osteotomy site will be included in the radiation field.

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“…5 Variations on the mandibulotomy technique have included a stair-step osteotomy, a parasymphyseal osteotomy, and a lateral osteotomy. 13 ' 14 The midline vertical osteotomy has been our choice over other techniques, for several reasons. 13 ' 14 The midline vertical osteotomy has been our choice over other techniques, for several reasons.…”

Section: Discussionmentioning

confidence: 99%

Transverse Lag Screw Fixation in Midline Mandibulotomy

Serletti¹,

Coniglio²,

Pacella³

et al. 2000

Ann Otol Rhinol Laryngol

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Vertical midline mandibulotomy has provided a relatively simple and efficient means of obtaining access to intraoral tumors that are too large or too posterior to be removed transorally. Midline mandibulotomy has had the advantage of nerve and muscle preservation and places the osteotomy outside the typical field of radiotherapy, in contrast to lateral and paramedian osteotomies. Plate and screw fixation has been the usual means of osteosynthesis for these mandibulotomies; however, plate contouring over the symphyseal surface has been a time-consuming process. Unless the plate was contoured exactly, mandibular malalignment and malocclusion in dentulous patients has occurred. Use of parallel transverse lag screws has become a popular method of osteosynthesis for parasymphyseal fractures, and we have extended their use for mandibulotomy fixation. This paper reports our clinical experience with transverse lag screw fixation of midline mandibulotomies in 9 patients from 1994 to 1997. There were 7 men and 2 women with a mean age of 56 (range 35 to 71 years). The pathological diagnosis in all patients was squamous cell carcinoma; 8 cases were primary, and 1 patient presented with recurrent tumor. No tumors involved the mandibular periosteum. One patient had had previous radiotherapy, and 3 patients underwent postoperative radiotherapy. The mean follow-up has been 17 months (range 9 to 27). There was 1 minor complication and 1 major complication related to our technique. The major complication was a delayed nonunion of the mandibulotomy. This occurred because the 2 parallel screws were placed too close to one another, and this placement resulted in a delayed sagittal fracture of the anterior cortex and subsequent nonunion. Transverse lag screw fixation has not affected occlusion in our dentulous patients. Speech and diet were normal in the majority of our patients. Transverse lag screw fixation of the midline mandibulotomy has been a relatively safe, rapid, and reliable method for tumor access and postextirpation mandibular stabilization and has significant advantages over other current methods of mandibulotomy and fixation.

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Approach to the Pterygomaxillary Space and Posterior Part of the Tongue by Lateral Stair-Step Mandibulotomy

Cited by 21 publications

References 5 publications

The mandibulotomy: Friend or foe? Safety outcomes and literature review

The mandibulotomy: Friend or foe? Safety outcomes and literature review

Mandibular Access Osteotomies in Oral Cancer

Transverse Lag Screw Fixation in Midline Mandibulotomy

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