EXTERNAL APPROACH TO THE FOSSA PTERYGOPAL ATINA AND THE OROPHARYNX BYTEMPORARY SAGITTAL MANDIBULOTOMY

Standard procedures for temporary mandibulotomy are medial or the late ral osteotomy. Median mandibulotomy is associated with destruction of anatomical structures in the floor of the mouth and with lateral osteo tomy no preservation of the nervus alveolaris inferior is possible. Th erefore, a modification of mandibulotomy is described with wide-field exposure, minimal functional defects and reduction of osteotomy-relate d complications. The first osteotomy is carried out vertically before the foramen mentale on the buccal compacta of the mandible. A second v ertical osteotomy is placed on the lingual compacta posterior to the m usculus myohyoideus. Horizontal osteotomies on the alveolar ridge and the basal ridge of the mandible are connected with the vertical osteot omies. Using a chisel, the lingual and the buccal part of the mandible are splitted sagittally with preservation of the nervus alveolaris in ferior located in the buccal fragment of the mandible. The two parts o f the mandible are divided to provide access to the oropharynx. Surgic al approach to the fossa pterygopalatina and the parapharyngeal space is reached with dissection of the mucosa along the ascending mandible, subluxation in the mandibular joint and reflection of the mandible cr anially and posteriorly. The wide access offers a lot of advantages es pecially in combination with a microvascular flap reconstruction. Fixa tion of the mandible is carried out with two titanium miniplates at th e anterior vertical osteotomy. The wide areas of the splitted bone mar row, resulting from sagittal splitting, achieved an exact adaptation o f the mandibular parts and an easy and sure fixation via miniplates. T herefore, postoperative radiation therapy can be started two weeks aft er the operation. The approach described above was used in 5 patients with oropharyngeal tumours, two patients with tumours of the fossa pte rygopalatina and in two cases with tumours of the parapharyngeal space . 7 patients underwent postoperative radiotherapy two weeks after the operation. In all cases we achieved an excellent exposure and all pati ents had an uncomplicated recovery with excellent functional results.