The median mandibulotomy approach for head and neck tumors

Background: Histologically proven radical resections are the goal in patien ts with head and neck cancer because of improved survival rates. The freque ncy of histologically radical resections using the median mandibulotomy and the morbidity of this approach for tumors of the oropharynx and the paraph aryngeal space are described in a patients series. Methods: The follow-up i ncludes 16 consecutive patients who were operated on by a median mandibulot omy approach between 1995 and 1998. The oncological benefit ( tumor free ma rgins), complications and the functional results (ability of opening the mo uth, mastication, swallowing, speech, cosmesis and pain) were reviewed. Res ults: In 15/16 cases a histological radical resection was achieved. 14 pati ents were irradiated postoperatively. In this group 3 patients had an osteo radionecrosis, one an osteomyelitis of the mandible. The functional results were worse in more advanced tumors. Conclusion: The indications for a medi an mandibulotomy are primarily T3 and T4 tumors of the oral cavity and orop harynx, rarely expansive benign parapharyngeal tumors. In most cases a hist ological radical resection is achieved even in advanced tumors, probably du e to the wide exposure of the involved area. in contrast this approach is a ssociated with a high morbidity.