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Min F, Qiu P, Zhu X, Zhou B, Lin Z, Pan C, Wang Y. Modified submandibular mandibulotomy approach versus lip-splitting approach in tongue cancer surgery: a retrospective paired-cohort study. Clin Oral Investig 2023; 28:32. [PMID: 38147089 DOI: 10.1007/s00784-023-05395-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES The surgical approach for resection and reconstruction of tongue cancer (TSCC) with or without the lip-splitting incision is controversial. This study introduced a modified approach without lip-splitting and the clinical results were assessed. METHODS Sixty-eight TSCC patients underwent surgery using the modified submandibular mandibulotomy (MSMM) approach without lip-splitting, and another matched 68 patients using lip-splitting mandibulotomy (LSM) approach were enrolled in this study. The clinical results including intraoperative relevance and surgical morbidities, survival status, facial appearance and scar scores, function of lower lip, and quality of life (QOL) were evaluated. RESULTS The primary tumors were en bloc resected through the MSMM approach with excellent tumor exposure and R0 resection margins as LSM approach. The survival status and complications were similar in both groups. The function of lower lip was better in patients of MSMM group at 1 month after surgery. The MSMM approach was associated with significantly better facial appearance and recreation compared to LSM approach by scar scores and QOL assessment. CONCLUSION The MSMM approach without lip-splitting achieves similar tumor control, better aesthetic results, and QOL compared to LSM approach. It is a safe and effective surgical approach for patients with TSCC. CLINICAL RELEVANCE The MSMM approach without lip-splitting is oncological safety in tongue cancer surgery and is scrutinized as one part of the treatment concept for better aesthetic results.
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Affiliation(s)
- Fu Min
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Rd, Guangzhou City, 510120, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou City, China
| | - Pingping Qiu
- Dpartment of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou City, China
| | - Xianbei Zhu
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Rd, Guangzhou City, 510120, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou City, China
| | - Bin Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Rd, Guangzhou City, 510120, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou City, China
| | - Zhaoyu Lin
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Rd, Guangzhou City, 510120, China
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou City, China
| | - Chaobin Pan
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Rd, Guangzhou City, 510120, China
| | - Youyuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Rd, Guangzhou City, 510120, China.
- The Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou City, China.
- Craniomaxillofacial Surgery Center, Sun Yat-Sen University, Guangzhou City, China.
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Binmadi N, Alsharif M, Almazrooa S, Aljohani S, Akeel S, Osailan S, Shahzad M, Elias W, Mair Y. Perineural Invasion Is a Significant Prognostic Factor in Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3339. [PMID: 37958235 PMCID: PMC10649820 DOI: 10.3390/diagnostics13213339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Objectives: This systematic review and meta-analysis aimed to summarize current evidence regarding the prognostic role of perineural invasion (PNI) in patients with oral squamous cell carcinoma (OSCC). (2) Methods: We searched Cochrane Central, ProQuest, PubMed, Scopus, Science Direct, and Web of Science, using relevant keywords to identify eligible articles. Two independent reviewers conducted two-stage screening, data extraction, and quality assessment. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) criteria. All analyses were performed using comprehensive meta-analysis (CMA; version 3.3.070) software. (3) Results: The study included 101 published articles encompassing 26,062 patients. The pooled analyses showed that PNI was associated with significantly worse overall survival (OS; HR = 1.45, 95% CI: 1.32-1.58; p < 0.001), worse disease-specific survival (DSS; HR = 1.87, 95% CI: 1.65-2.12; p < 0.001), and worse disease-free survival (DFS; HR = 1.87, 95% CI: 1.65-2.12; p < 0.001). Similarly, both local recurrence-free survival (LRFS) and regional recurrence-free survival (RRFS) were worse in patients with PNI (HR = 2.31, 95% CI: 1.72-3.10, p < 0.001; and HR = 2.04, 95% CI: 1.51-2.74, p < 0.001), respectively. The random-effect estimate of three studies demonstrated that the presence of PNI was associated with worse failure-free survival (FFS; HR = 2.59, 95% CI: 1.12-5.98, p < 0.001). (4) Conclusions: The current evidence suggests that PNI can be used as an independent predictor of the prognosis for patients with OSCC. The presence of PNI was associated with worse OS, DFS, DSS, FFS, and with recurrence. Asian patients and patients with extra-tumoral or peripheral PNI invasion were associated with worse prognosis.
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Affiliation(s)
- Nada Binmadi
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Maha Alsharif
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Soulafa Almazrooa
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Suad Aljohani
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Sara Akeel
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Samira Osailan
- Department of Oral and Maxillofacial Surgery, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia
| | - Muhammad Shahzad
- Institute of Basic Medical Sciences, Khyber Medical University, Hayat Abad Phase 5, Peshawar 25110, Pakistan;
- School of Biological Sciences, Health and Life Sciences Building, University of Reading, Reading RG6 6AX, UK
| | - Wael Elias
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Yasmin Mair
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
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Wang Y, Zhou B, Liu Z, Rui T, Pan C, Chen W. Modified submandibular mandibulotomy approach without lip-splitting in tongue cancer. J Plast Reconstr Aesthet Surg 2022; 75:3877-3903. [DOI: 10.1016/j.bjps.2022.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 04/21/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
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Li J, Liu S, Li Z, Han X, Que L. Prognostic Value of Perineural Invasion in Oral Tongue Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:683825. [PMID: 34322385 PMCID: PMC8311439 DOI: 10.3389/fonc.2021.683825] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/24/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES A significant number of recently published research has outlined the contribution of perineural invasion (PNI) to clinical outcomes in oral tongue squamous cell carcinoma (OTSCC), but some results remain conflicting. This study aimed to determine whether patients with OTSCC with PNI have a worse prognosis than those without PNI. MATERIALS AND METHODS PubMed, Embase, and the Cochrane Library were queried for potentially eligible articles published up to December 2020. The primary outcomes were the hazard ratio (HR) for locoregional recurrence, overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS). The random-effect model was used in all analyses. RESULTS Seventeen studies (4445 patients) were included. Using adjusted HRs, the presence of PNI was associated with a higher risk of locoregional recurrence (HR=1.73, 95%CI: 1.07-2.79, P=0.025, I2 = 33.1%, Pheterogeneity=0.224), worse OS (HR=1.94, 95%CI: 1.39-2.72, P<0.001, I2 = 0.0%, Pheterogeneity=0.838), worse DFS (HR=2.13, 95%CI: 1.53-2.96, P<0.001, I2 = 48.4%, Pheterogeneity=0.071), and worse CSS (HR=1.93, 95%CI: 1.40-2.65, P<0.001, I2 = 25.5%, Pheterogeneity=0.251). PNI had an impact on locoregional recurrence in early-stage OTSCC but not in all stages, and on OS, DFS, and CSS in all-stage and early-stage OTSCC. The sensitivity analyses showed that the results were robust. CONCLUSION The presence of PNI significantly affects the locoregional recurrence and survival outcomes among patients with OTSCC.
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Affiliation(s)
- Jiajia Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shan Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhangao Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xinxin Han
- Department of Pediatric Dentistry, School of Stomatology, The Fourth Military Medical University, Xi’an, China
| | - Lin Que
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Böger D, Hartmann R, Sauer M. [Critical aspects of the transmandibular approach to the oral cavity and oropharynx]. HNO 2021; 70:110-116. [PMID: 34170338 DOI: 10.1007/s00106-021-01073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the context of tumor surgery, the median mandibulotomy as an access route to the oral cavity and oropharynx provides an excellent overview of the surgical site. However, it is not regarded entirely unproblematic with regard to early and later complications that may arise. OBJECTIVE The results and complications of the median mandibulotomy will be presented based on data collected from our own patient collective. MATERIALS AND METHODS A total of 21 patients who had undergone a median mandibulotomy as part of tumor surgery at the Department of Otorhinolaryngology of the SRH Zentralklinikum Suhl were examined over a period from 01 January 2010 to 31 December 2020. The patient files were retrospectively evaluated. RESULTS A stair-step median mandibulotomy was performed in all 21 patients. Reconstruction was performed using a 2.8 mm thick angled mandibular plate and bicortical locking screws. The mean follow-up period was 29.8 months. In all, 7 patients (33%) had a recurrence at the time of surgery; 5 patients (24%) had already undergone pre-radiation. Furthermore, 18 patients (85.7%) received adjuvant radiotherapy. We found plate loosening or extrusion in 0 of 21 cases. A salivary fistula (4.7%) was observed in 1 patient. Trismus was found in 4 (19%) cases during follow-up. Osteoradionecrosis was found in 2 (9.5%) of 21 cases. Cosmetic deficits were not observed. CONCLUSION Our results show that the stair-step median mandibulotomy in combination with a 2.8 mm thick reconstruction plate and bicortical locking screws leads to a stable and safe reconstruction even with pre-irradiated situations. Plate loosening or extrusion did not occur.
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Affiliation(s)
- D Böger
- Klinik für Hals‑, Nasen- und Ohrenkrankheiten/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland.
| | - R Hartmann
- Klinik für Hals‑, Nasen- und Ohrenkrankheiten/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland
| | - M Sauer
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland
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Mansour N, Backes C, Becker C, Hofauer B, Knopf A. [Clear resection margins to avoid escalation of adjuvant therapy in oropharyngeal squamous cell carcinoma]. HNO 2021; 69:256-262. [PMID: 32975607 PMCID: PMC7997822 DOI: 10.1007/s00106-020-00932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Resection margins in patients with oropharyngeal squamous cell carcinoma (OPSCC) are a predictive marker for overall survival (OS) and recurrence-free interval (RFI). Adjuvant therapy is influenced by TNM status, extracapsular extension (ECE), and resection margin status (R) of the primary tumor. The R status can be directly influenced by the head and neck surgeon. The aim of the current study was to evaluate the impact of R status on treatment decisions, RFI, and OS. MATERIALS AND METHODS All patients with OPSCC who underwent surgery (with/without adjuvant therapy) between 2001 and 2011 were enrolled. Clinical data, survival parameters, histologic data such as ECE, resection margin status, and tumor size were retrospectively collected and analyzed. RESULTS A total of 208 patients were enrolled. Survival parameters showed that patients with microscopically clear (R0) resection margins had an RFI/OS of 89/87 months. These values decreased in patients with R1 (65/65 months), R2 (38/33 months), and Rx (unclear) resections (59/45 months; p = 0.036/p = 0.001). In patients with ECE and R1 resection, but also in those with R0 resections achieved by follow-up resection and those with Rx resections, adjuvant therapy was escalated. CONCLUSION Unclear resection status reduces OS and RFI in patients with OPSCC. Therefore, in surgical therapy, clear resection status in the first pass should be strived for to avoid escalation of adjuvant therapy due to an unclear R status.
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Affiliation(s)
- N Mansour
- Klinik für Hals, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
| | - C Backes
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - C Becker
- Klinik für Hals, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - B Hofauer
- Klinik für Hals, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - A Knopf
- Klinik für Hals, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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The impact of lip-split mandibulotomy on patients treated for pT2 oral tongue squamous cell carcinoma: a study of 224 patients. Oral Maxillofac Surg 2020; 25:313-318. [PMID: 33141300 DOI: 10.1007/s10006-020-00918-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Head and neck surgeons often face a challenge in order to achieve adequate three-dimensional resection of tumours in the oral cavity, especially in the dentate patient. METHODS We compared the outcomes of lip-split mandibulotomy and trans-oral access, respectively, in patients treated for primary pT2 oral tongue SCC with regard to the status of the resection margins and the incidence of tumour recurrence. RESULTS Multivariate analysis showed a non-significant effect of the surgical technique used to the reported recurrence, F(1, 224) = 0.350, p = .555 and a significant effect on the margins achieved F(1, 224) = 11.381, p = .001. CONCLUSIONS Defects after excision of larger and more posterior tumours that are going to be reconstructed with free flaps represent a more probable indication for using an osteotomy access technique. Lip-split mandibulotomy is a low-morbidity technique which can deliver a sound oncological outcome and can be relatively easily taught to less experienced surgeons.
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Wu JJ, Gao X, Wang WJ, Aly G, Chen J, Hu YQ, Jian XC, Jiang CH. [Influence of mandibulotomy approaches on oral function following radical resection of tongue carcinoma]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:280-283. [PMID: 32573135 DOI: 10.7518/hxkq.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to compare the influences of postoperative oral function in patients with median or paramedian mandibulotomy during the radical resection of tongue carcinoma and to provide evidence for the choice of osteotomy location for mandibulotomy. METHODS The clinical data of 126 patients who underwent combined radical neck dissection with mandibulectomy and glossectomy followed by simultaneous reconstruction were analyzed retrospectively. The patients were divided into two groups according to the position of mandibulotomy: median mandibulotomy group (median group, n=60) and paramedian mandibulotomy group (paramedian group, n=66). The fourth edition of the University of Washington Quality of Life Questionnaire (UW-QOL) was used to compare the differences in oral functions, such as swallowing, mastication, and speech, between the two groups during regular follow-up. SPSS 24.0 software package was used for statistical analysis, and P<0.05 was considered statistically significant. RESULTS Six months after the operation, no significant differences in swallowing, mastication, and speech functions were found between the median and paramedian groups. However, the swallowing and speech functions in the paramedian group were better than those in the median group 1 year after the operation (P<0.05), whereas no statistical difference in mastication function was observed between the two groups. CONCLUSIONS Evaluation of the postoperative oral function results showed that paramedian mandibulotomy was a better surgical approach than median mandibulotomy. Paramedian mandibulotomy is worth prioritizing in the radical resection of tongue carcinoma.
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Affiliation(s)
- Jian-Jun Wu
- Dept. of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xing Gao
- Dept. of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wen-Jin Wang
- Dept. of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Gomaa Aly
- Dept. of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jie Chen
- Dept. of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Ya-Qin Hu
- Dept. of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xin-Chun Jian
- Dept. of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Can-Hua Jiang
- Dept. of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
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Analysis of an in-house technique for temporary mandibulotomy and its impact on postoperative radiotherapy. Int J Oral Maxillofac Surg 2018; 48:468-474. [PMID: 30527675 DOI: 10.1016/j.ijom.2018.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/20/2018] [Accepted: 11/16/2018] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to describe a newly developed procedure for temporary mandibulotomy and subsequent osteosynthesis. Clinical outcomes were evaluated, including complications and the impact on postoperative treatment, particularly postoperative radiotherapy. Twenty-four patients underwent temporary mandibulotomies for the surgical resection of malignancies located in the posterior oral or oropharyngeal region. All were treated with postoperative radiotherapy. An angulated median mandibulotomy was followed by osteosynthesis with three anchor screws directed towards the inferior aspect of the mandible. Anchor screws are modified conventional lag screws that include an additional biconcave washer. This modification prevents the screw heads from cracking into the cancellous bone during tightening, improving their biomechanical qualities considerably. Insertion of screws at any angle to the bony surface therefore becomes possible, which is a precondition for this technique. Minor complications occurred in two patients in the early postoperative period. However, complications causing bony non-union, leading to postponed postoperative radiotherapy were not noted in this cohort.
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