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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Castagnola R, Rupe C, Gioco G, Almadori G, Galli J, Tagliaferri L, Cassano A, Gallenzi P, Lajolo C. Clinical outcomes of teeth adjacent to the site of mandibulotomy or mandibulectomy in patients with head and neck cancer: results from a multidisciplinary mono-institutional head and neck tumor board. BMC Oral Health 2023; 23:357. [PMID: 37270480 DOI: 10.1186/s12903-023-03050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/15/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION The aim of this case series was to evaluate the necrosis of teeth adjacent to the site of mandibulotomy or mandibulectomy in a cohort of patients suffering from head and neck cancers. METHODS Fourteen patients who underwent segmental mandibulectomy or paramedian mandibulotomy for oral, oropharynx or major salivary gland cancer and a total of 23 teeth were included in this case series. Twelve patients underwent adjuvant head and neck radiotherapy. Cold sensitivity pulp testing and/or electric pulp testing were performed on teeth at the margin of mandibulectomy and on teeth adjacent to mandibulotomy after surgery. A "positive" response was considered the healthy state, and "negative" was considered the diseased state of the tooth. RESULTS The 10 patients who underwent mandibulotomy had 12 teeth with a negative response. The 4 patients treated by mandibulectomy had two positive and three negative responses to cold and electric pulp tests. Fifteen out of 23 teeth (65.2%) showed a negative response to sensitivity testing. CONCLUSIONS Tooth necrosis seems to be a common event after mandibulectomy and mandibulotomy. CLINICAL RELEVANCE To avoid post-surgery complications, performing root canal therapy before surgery on the teeth adjacent to the surgical site could be an appropriate strategy.
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Affiliation(s)
- Raffaella Castagnola
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - Cosimo Rupe
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, 00168, Italy.
| | - Gioele Gioco
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - Giovanni Almadori
- Head and Neck Department, Institute of Otolaryngology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - Jacopo Galli
- Head and Neck Department, Institute of Otolaryngology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - Luca Tagliaferri
- Department of Radiation Oncology, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - Patrizia Gallenzi
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, 00168, Italy
| | - Carlo Lajolo
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, 00168, Italy
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Munnangi A, Kadapathri A, Pillai V, Bhat S, Rajeswarie RT, Shetty V, Subramanium N, Kolur T, Bhushan R V. Isolated Infratemporal Fossa Desmoid Fibromatosis: A Rare Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:2609-2613. [PMID: 36452559 PMCID: PMC9702405 DOI: 10.1007/s12070-020-02294-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022] Open
Abstract
Desmoid fibromatosis (DF) arising from musculoaponeurotic structures rarely affects the head and neck region with the abdomen being the most common site of origin. These are benign tumors with locally infiltrative nature usually presenting as painless swellings that are rapidly growing. The infratemporal fossa DF is an extremely rare location with few clinical reports. This article discusses the management of a 2-year-old child with DF of the infratemporal fossa (ITF) along with literature review.
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Affiliation(s)
- Ashwini Munnangi
- Head and Neck Oncology, Mazumdar Shaw cancer center, Bangalore, India
| | | | - Vijay Pillai
- Head and Neck Oncology, Mazumdar Shaw cancer center, Bangalore, India
| | - Sunil Bhat
- Pediatric Hematology/Oncology, Mazumdar Shaw cancer center, Bangalore, India
| | | | - Vivek Shetty
- Head and Neck Oncology, Mazumdar Shaw cancer center, Bangalore, India
| | | | - Trupti Kolur
- Head and Neck Oncology, Mazumdar Shaw cancer center, Bangalore, India
| | - Vidya Bhushan R
- Head and Neck Oncology, Mazumdar Shaw cancer center, Bangalore, India
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Dwivedi G, Gupta V, Tiwari V, Patnaik U, Sood A, Kumari A, Bharadwaja S. Different Approaches to the Overlapping Infratemporal Fossa and Parapharyngeal Spaces: a Case Series and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:2337-2343. [PMID: 36452571 PMCID: PMC9702234 DOI: 10.1007/s12070-020-02168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Parapharyngeal space and infratemporal fossa are 2 overlapping spaces in head and neck which have complex anatomy with vital neurovascular structures passing through them. Tumors of this region are extremely rare but majority of them (80%) are benign. Benign tumors of this region can lead to swellings in facial region, neck and oropharynx. Dysphagia may be a complaint of the patient. Many of these tumors have malignant potential. Removal of these tumors requires a good understanding of the anatomy of this space so that correct surgical approach can be selected. The surgeon needs to be adept in using the most suitable surgical approach for excision of these tumors. There are various approaches which can be used to access these deeply seated tumors but the issue of prime importance is selecting the appropriate approach for the various tumors here based on their size and their exact location in this complex anatomical space. Inappropriate approach can lead to inadequate tumor excision and can lead to injuries to the neurovascular structures in this region which can cause significant disability. The case series reported here describes the various approaches to this region and highlights the importance of correct selection of the surgical approach.
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Affiliation(s)
| | | | | | | | - Amit Sood
- Department of ENT, CHSC, AFMC, Pune, India
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Khunteta N, Katta P, Badwal JS, Ojha T. The Mandible Sparing "POSC Technique" for Management of Middle and Posterior Third Tongue Cancers. Indian J Otolaryngol Head Neck Surg 2021; 73:252-256. [PMID: 34150600 DOI: 10.1007/s12070-021-02535-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
Cancer of the tongue forms more than 50% of oral cavity cancers. Generally, patients come with locally advanced tongue cancer. The treatment for this cancer is multi-modality. For resectable cancer, multiple surgical approaches are described in the literature. Mandibulotomy for resection of the middle and posterior third oral cancer is a well-established technique but it has its attended morbidity. We present our results of a new surgical technique, called the Peroral and submandibular cervical surgical approach wherein tongue cancer of middle third and posterior third is resected without mandibulotomy. The advantages of this technique are that the complications of malunion or non-union of bone are avoided, no chances of osteoradionecrosis or osteomyelitis, no need of periosteal elevation or damage, the malignancy is removed with wide margin with minimal blood loss, there is no scar on face or chin, morbidity of surgery is minimal. Also, the technique is easily reproducible.
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Affiliation(s)
- Nitin Khunteta
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi Hospital, Mahatma Gandhi University of Medical Sciences and Technology, Sitapura, Jaipur, Rajasthan India
| | - Prakhar Katta
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi Hospital, Mahatma Gandhi University of Medical Sciences and Technology, Sitapura, Jaipur, Rajasthan India
| | - Jaspreet Singh Badwal
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi Hospital, Mahatma Gandhi University of Medical Sciences and Technology, Sitapura, Jaipur, Rajasthan India
| | - Tarun Ojha
- Department of ENT - Head and Neck Surgery, Mahatma Gandhi Hospital, Mahatma Gandhi University of Medical Sciences and Technology, Sitapura, Jaipur, India
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Anehosur V, Bindal M, Kumar N, Shetty C. Mandibulotomy Approach for Resection of Maxillary Tumours: A Clinical Review. J Maxillofac Oral Surg 2019; 18:360-365. [PMID: 31371874 DOI: 10.1007/s12663-018-1164-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/03/2018] [Indexed: 12/01/2022] Open
Abstract
Purpose The objective of this study was to assess the accessibility in the resection of maxillary tumours, resection margin status, and morbidity following maxillectomy through lip split with paramedian mandibulotomy approach. Materials and Methods A retrospective review of 20 consecutive patients who underwent maxillectomy with resection of primary tumours through lip split mandibulotomy approach with supraomohyoid neck dissection for maxillary tumours between 2008 and 2016. Patients details including the tumours site, extension and neck node involvement. were recorded. Resection technique, status of surgical resected margins was also discussed. Disease status was obtained from patients follow up records. Morbidity was assessed at mandibulotomy site in terms of infection, osteotomy healing, neural disturbance and mouth opening. The institutional research committee approval was taken for this study. Results All patients underwent adequate en bloc resection of the tumours, except in two patients in whom superior margins was positive. Osteotomy site healed well in our all patients except in one patient in whom there was infection at the osteotomy site during post radiation therapy. Minimal neural morbidity was encountered in four patients (three patients had lingual nerve hypothesia and two patients had inferior alveolar nerve hypothesia) which recovered in all four patients, over the 6th month post-operative period. Post-operative interincisal distance was satisfactory with a mean of 30.5 mm. Conclusion Mandibulotomy with lip split is considered to be an ideal approach to access tumours of maxilla and its adjacent structures, SOHND with level III clearance. This approach provide excellent accessibility for en bloc resection of operable maxillary tumours with good outcome of resultant scar and minimal morbidity.
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Affiliation(s)
- Venkatesh Anehosur
- 1SDM Craniofacial Surgery and Research Centre, SDM College of Dental Science and Hospital, Dharwad, Karnataka India
| | - Mohit Bindal
- 1SDM Craniofacial Surgery and Research Centre, SDM College of Dental Science and Hospital, Dharwad, Karnataka India
| | - Niranjan Kumar
- 2SDM College of Medical Science and Hospital, Dharwad, Karnataka India
| | - Chaitra Shetty
- 1SDM Craniofacial Surgery and Research Centre, SDM College of Dental Science and Hospital, Dharwad, Karnataka India
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Markou K, Blioskas S, Krommydas A, Psillas G, Karkos P. Transoral Resection of Giant Parapharyngeal Space Tumors via a Combined Surgical Approach. Iran J Otorhinolaryngol 2019; 31:87-96. [PMID: 30989074 PMCID: PMC6449533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Parapharyngeal space (PPS) tumors account for 0.5% of the head and neck neoplasms. Based on the evidence, 80% of these tumors are of a benign nature. Surgical excision is the treatment of choice for this condition. The present study was conducted to propose transoral resection as an efficient way to excise the benign well-defined tumors of the PPS. MATERIALS AND METHODS This retrospective case series study was conducted on seven patients undergoing the transoral excision of the sizeable masses of the PPS via a combined approach. Computed tomography and magnetic resonance scans revealed giant masses in the PPS in all cases. These neoplasms were preoperatively diagnosed as well-delineated, non-vascular, and benign. RESULTS All patients underwent transoral tumor excision preceded by an auxiliary transcervical approach, which served as an assurance for the dissection and preservation of the cranial nerves and neurovascular bundle without any tumor spillage. Average hospital stay was limited to a maximum of 3 days, and all patients had an uneventful postoperative course. The follow-up examination did not indicate any recurrence. CONCLUSION Based on the findings, transoral resection can be concluded as an efficient way to excise benign, well-defined tumors of the PPS. This procedure appears to be safe when a secondary transcervical approach is applied. Given the unnecessity of performing mandibulotomy in this procedure, it is expected to have lower morbidity and fewer complications.
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Affiliation(s)
- Konstantinos Markou
- Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece.
| | - Sarantis Blioskas
- Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece.,Corresponding Author: Department of Otorhinolaryngology - Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece, Tel:+302310994925, E-mail:
| | - Argyrios Krommydas
- Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece.
| | - George Psillas
- Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece.
| | - Petros Karkos
- Department of Otorhinolaryngology - Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi St, 54636 Thessaloniki, Greece.
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Abstract
Parapharyngeal tumors are relatively rare tumors of head and neck. In general, pleomorphic adenoma is one of the most common benign tumor of the parapharyngeal region. Various approaches have been described in the literature for removal of parapharyngeal tumor with mandibulotomy generally carried out for large tumors. Here, we describe removal of a large parapharyngeal pleomorphic adenoma transcervically without mandibulotomy which subsequently turned out to be one of the largest ever reported in the literature and describe how large tumors of parapharyngeal can be removed with minimal invasive approach with mandibulotomy kept as a backup thereby avoiding complications associated with mandibulotomy.
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Affiliation(s)
- Vikas Malhotra
- Department of ENT and Head and Neck Surgery, Maulana Azad Medical College, New Delhi, India
| | - Nikhil Arora
- Department of ENT and Head and Neck Surgery, Maulana Azad Medical College, New Delhi, India
| | - Varun Rai
- Department of ENT and Head and Neck Surgery, Gangaram Hospital, New Delhi, India
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Biron VL, O'Connell DA, Barber B, Clark JM, Andrews C, Jeffery CC, Côté DWJ, Harris J, Seikaly H. Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis. J Otolaryngol Head Neck Surg 2017; 46:20. [PMID: 28292318 PMCID: PMC5351107 DOI: 10.1186/s40463-017-0196-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background The resection of large oropharyngeal tumors traditionally involves a lip-splitting mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect. Transoral robotic surgery (TORS) has emerged as a technique that can resect large and complex oropharyngeal tumors, avoiding a lip-splitting approach. The aim of this study is to compare the lip-splitting mandibulotomy approach versus TORS for the management of advanced stage oropharyngeal carcinomas. Methods Prospectively collected data from 18 patients with advanced stage oropharyngeal squamous cell carcinoma (OPSCC) who received TORS with radial forearm free flap reconstruction (RFFF) was compared to a matched cohort of 39 patients who received a lip-splitting mandibulotomy and RFFF. Patients were matched for stage, p16 positivity, smoking, age and gender. Length of hospital stay (LOHS), tracheostomy decanulation time, operative time, surgical margin status, and post-operative complications were compared between groups. Results Patients who received TORS with RFFF had a significantly lower mean LOHS, compared to patients who were treated by lip-splitting mandibulotomy and RFFF (14.4 vs 19.7 days, p = 0.03). No significant differences were seen between groups in terms of operative time, tracheostomy decannulation time, margin positivity and post-operative complications. Conclusion TORS with radial forearm free flap reconstruction is a safe, effective and cost-saving alternative to the lip-splitting mandibulotomy approach for the treatment of advanced stage OPSCC.
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Affiliation(s)
- Vincent L Biron
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada. .,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada.
| | - Daniel A O'Connell
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada
| | - Brittany Barber
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Jessica M Clark
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Colin Andrews
- Faculty of Medicine and Dentistry, Undergraduate Medical Education, Edmonton, AB, Canada
| | - Caroline C Jeffery
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - David W J Côté
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Jeffrey Harris
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada
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Al-Saleh MAQ, Punithakumar K, Lagravere M, Boulanger P, Jaremko JL, Wolfaardt J, Major PW, Seikaly H. Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy. J Otolaryngol Head Neck Surg 2017; 46:8. [PMID: 28129794 PMCID: PMC5273832 DOI: 10.1186/s40463-017-0184-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The midline and paramedian mandibulotomy are surgical procedures that divide the mandibular bone into two halves and disconnects the condylar heads of the TMJ from each other. This study aimed to prospectively evaluate the temporomandibular joint (TMJ) functional and morphological changes after mandibulotomy using a reconstructed 3D models of the TMJ. METHODS Sixteen adult patients diagnosed with oral and oropharyngeal tumors with planned surgical mandibulotomy (test group, 9 patients) or transoral (control group, seven patients) treatments were included in the study. MRI and CBCT images were obtained immediately preceeding surgery and 6-8 weeks after surgery. Using the MRI-CBCT registered images, TMJ tissues were segmented at the two occasions by the same operator and 3D models were reconstructed for morphological assessment. Changes across time were measured using the volume overlap and Hausdorff distance of the disc and condyle 3D models. Disc-condyle relationship was measured using point-based and color map analysis. To assess the early functional changes, the Jaw function limitation scale (JFLS) and the maximum mouth opening were measured. Two-sample Hotelling T2 t-test was performed to determine the significance of the morphological and clinical outcomes' differences between the two groups. RESULTS The two-sample Hotelling T2 t-test showed significant differences (T2 (df1,df2) = 0.97 (5,26), p <0.01) between the mean values of all outcomes among the 2 groups. The change in disc displacement was significantly different between the two groups (p <0.05). However, the condylar displacement was not significantly different between the two groups (p =0.3). The average of the JFLS score was five times larger after mandibulotomy, and was 2 times larger after transoral surgery (p < 0.01). Patients showed decrease in the average of the maximum interincisal mouth opening by 11 mm after mandibulotomy, and by 5.4 mm after transoral surgery. CONCLUSION The quantitative assessment of the TMJ showed minimal changes of the condylar position and variable degrees of articular disc displacement associated with the paramedian split mandibulotomy. As well, limited jaw functions and vertical mouth opening were noticed more in the mandibultomy group compared to the transoral group in 6- weeks after surgery.
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Affiliation(s)
- Mohammed A Q Al-Saleh
- Orthodontic Graduate Program, School of Dentistry, University of Alberta, 476 Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, T6G 1C9, Canada.
| | - Kumaradevan Punithakumar
- Servier Virtual Cardiac Centre, Mazankowski Alberta Heart Institute and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.,Department of Computing Science, Faculty of Science, University of Alberta, Athabasca Hall, Room 411, Edmonton, Alberta, T6G 2E8, Canada
| | - Manuel Lagravere
- Orthodontic Graduate Program, School of Dentistry, University of Alberta, 476 Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, T6G 1C9, Canada
| | - Pierre Boulanger
- Servier Virtual Cardiac Centre, Mazankowski Alberta Heart Institute and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.,Department of Computing Science, Faculty of Science, University of Alberta, Athabasca Hall, Room 411, Edmonton, Alberta, T6G 2E8, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, 2A2.41 WC Mackenzie Health Science Center, Edmonton, Alberta, T6G 2R7, Canada
| | - John Wolfaardt
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 16940-87 Avenue, Edmonton, Alberta, T5R 4H5, Canada
| | - Paul W Major
- Orthodontic Graduate Program, School of Dentistry, University of Alberta, 476 Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, T6G 1C9, Canada
| | - Hadi Seikaly
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 16940-87 Avenue, Edmonton, Alberta, T5R 4H5, Canada
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BASARAN B, POLAT B, UNSALER S, ULUSAN M, ASLAN I, HAFIZ G. Parapharyngeal space tumours: the efficiency of a transcervical approach without mandibulotomy through review of 44 cases. Acta Otorhinolaryngol Ital 2014; 34:310-6. [PMID: 25709146 PMCID: PMC4299156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/06/2014] [Indexed: 11/03/2022]
Abstract
The aim of this study was to describe our experience with benign parapharyngeal space tumours resected via a transcervical route without mandibulotomy and to investigate associated postoperative sequelae and complications. The study investigated and analysed the retrospective charts of 44 patients who underwent surgery for benign parapharyngeal space tumours over a 10-year period. The diagnosis was reached in all patients with clinical and radiologic findings; preoperative fine-needle aspiration biopsy was not performed in any case. The preferred means of accessing the parapharyngeal space in all patients was a transcervical route. In 5 of these patients, transparotid extension was performed due to the position of the tumour. Tumours were classified radiologically as poststyloid in 27 cases and prestyloid in 17 cases. The final histopathologic diagnosis was vagal paraganglioma in 16 cases, pleomorphic adenoma in 13 cases, schwannoma in 10 cases and comparatively rarer tumours in the remaining 5 cases. In three patients, cranial nerve paralysis was observed during preoperative evaluation. Permanent cranial nerve paralysis occurred in 19 cases (43.2%) in the postoperative period, the majority of which were neurogenic tumours such as vagal paraganglioma (n = 16) and schwannoma (n = 2), and one case of non-neurogenic parapharyngeal tumour. The median duration of follow-up was 61 ± 33 months. There was no local recurrence in any patient during the follow-up period. A transcervical approach should be the first choice for excision of parapharyngeal space tumours, except for recurrent or malignant tumours, considering its advantages of providing direct access to the neoplasm, adequate control of neurovascular structures from the neck and optimal aesthetic outcomes due to preservation of mandibular continuity with minimal morbidity and hospitalisation time.
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Affiliation(s)
- B BASARAN
- Address for correspondence: Bora Basaran, Istanbul Tıp Fakültesi Hastanesi, KBB AD, 34093, Fatih/Capa, Istanbul, Turkey. Tel. 90 532 4538608. Fax 90 212 4142359. E-mail:
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Abstract
PURPOSE To review the 5-year outcomes of our modified mandibulotomy technique. Retrospective review of a tertiary level oral cancer center. MATERIALS AND METHODS During a 5-year period, 30 patients who had a uniform surgical technique consisting of a lower lip-splitting, modified stair-step osteotomy with thin saw blade and osteotome after plate-precontouring and combination fixation with monocortical osteosynthesis (miniplate) and bicortical osteosynthesis (maxiplate and bicortical screws), with at least 14 months postoperative follow-up, were selected and reviewed retrospectively. RESULTS There were 8 women and 22 men with an average age of 56.5 years. All the patients involved malignancies were squamous cell carcinoma. The main primary sites of the those who underwent a mandibulotomy were the tonsil, the base of tongue, the oral tongue, the retromolar pad area, and others. Others included buccal cheek, floor of mouth, and soft palate. 23 patients received postoperative radiation therapy, and among whom 8 patients also received chemotherapy. Total four (13%) mandibulotomy-related complications occurred, only two (6.7%) requiring additional operation under general anesthesia. CONCLUSION Our modified mandibulotomy meets the criteria for an ideal mandibulotomy technique relatively well because it requires no intermaxillary fixation, can precise preserve the occlusion in a precise way, allows early function, requires no secondary procedures, and has few complications.
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Affiliation(s)
- Hye-Young Na
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Eun-Joo Choi
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Eun-Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
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