Osteoradionecrosis with Combined Mandibulotomy and Marginal Mandibulectomy

Abstract

Simultaneous anterior mandibulotomy and marginal mandibulectomy results in a high morbidity rate of avascular necrosis of the mandible and therefore should be avoided. To avoid a disastrous complication, segmental mandibulectomy and a composite free fibular osteoseptocutaneous flap reconstruction would be a preferred surgical alternative.

Oropharyngectomy without mandibulotomy in advanced stage (T3–T4) oropharyngeal cancer

“…In contrast, in our series, without a mandibulotomy, none of our patients developed the complications that follow a mandibulotomy. Likewise, in our patients, undergoing a marginal mandibulectomy without mandibulotomy, the frequency of complications due to radionecrosis is much lower than in those patients undergoing a marginal mandibulectomy and mandibulotomy presented by other studies [24]. In fact, of the nine patients in our series undergoing a marginal mandibulectomy, only four developed osteoradionecrosis (44%); this is clearly in contrast to the frequency of radionecrosis in patients undergoing a marginal mandibulectomy and mandibular osteotomy, which can be as high as 71% [24].…”

“…Likewise, in our patients, undergoing a marginal mandibulectomy without mandibulotomy, the frequency of complications due to radionecrosis is much lower than in those patients undergoing a marginal mandibulectomy and mandibulotomy presented by other studies [24]. In fact, of the nine patients in our series undergoing a marginal mandibulectomy, only four developed osteoradionecrosis (44%); this is clearly in contrast to the frequency of radionecrosis in patients undergoing a marginal mandibulectomy and mandibular osteotomy, which can be as high as 71% [24]. Consequently, if a mandibulotomy is not performed, more patients can benefit from conservative techniques, such as marginal mandibulectomy, with excellent local tumor control [25].…”

“…The reduction in the rate of osteoradionecrosis reduces the incidence of related complications and the requirement for complex corrective surgery using microvascularized flaps. In contrast to Wang et al [24], who recommend segmental mandibulectomy with microvascular reconstruction of the mandible, instead of mandibulotomy plus marginal mandibulectomy, we suggest a marginal mandibular resection whenever safe margins can be achieved and completion of the oropharyngectomy using our pull-through maneuver without a mandibulotomy.…”

Transoral Robotic-Assisted Surgery for Head and Neck Squamous Cell Carcinoma

“…Open approaches are often associated with multiple morbidities including cosmetic deformity, malocclusion, and dysphagia. [20][21][22] Numerous studies have observed shorter operative time, decreased hospital stay, and faster return to normal function in patients undergoing TORS. Average hospital stay ranges from 2 to 7 days.…”

Prognostic impact of marginal mandibulectomy in the presence of superficial bone invasion and the nononcologic outcome

“…Inadequate support from the mandible affects all of the above-mentioned functions. 2 However, it is still a major challenge for head and neck surgeons to come to a consensus on what is considered to be an appropriate extent of mandibulectomy to achieve an adequate oncologic control. Segmental mandibulectomy can result in serious functional and cosmetic deficits.…”