COMPARATIVE-EVALUATION OF FIXATION METHODS AFTER MANDIBULOTOMY FOR OROPHARYNGEAL TUMORS

Mandibulotomy for gaining access to the posterior aspect of the oral c avity and oropharynx for excision of tumors has been widely employed f or several decades. However, the technical aspects of the procedure co ntinue to evolve. This study compares the complications and bony union rates in a consecutive series of 135 patients undergoing mandibulotom y at 1 institution between 1987 and 1991, using wires and miniplates. The primary tumor sites were oral cavity in 35 patients, oropharynx in 98, and deep lobe of the parotid gland in 2. Twenty-eight patients we re previously irradiated, and 62 received postoperative radiotherapy. Thirty-eight patients had a straight-line osteotomy, 31 had step osteo tomy, and 66 had notched osteotomy. The fixation of the osteotomy site was done with wires in 59 patients and miniplates and screws in 76 pa tients. The duration of follow-up ranged from 1 to 5 years. No differe nce in complications or bony union was observed in patients who underw ent repair with wires or miniplates. Due to the number of surgeons and their preferences for different types of osteotomies, as well as the differences in surgical techniques, we further studied the 2 methods o f fixation employed by 1 surgeon who performed notched osteotomies on all of his patients (56 patients). Twenty-two underwent repair with wi res, and 34 with miniplates. Four patients with wires and seven with m iniplates developed wound complications requiring removal of wires in two and miniplates in one. Delayed union or nonunion was not observed in any patient. Fixation with wires or miniplates is equally satisfact ory as long as adequate immobilization of the mandibular segments is a chieved.