Morbidity after midline mandibulotomy and radiation therapy

Purpose: To assess the morbidity of mandibulotomy in patients treated for n eoplasms of the oropharynx and oral cavity, and to determine if postoperati ve radiation therapy to the mandibulotomy site carries an increased risk of complications. Patients and Methods: The medical charts of 30 patients treated between 199 2 and 1996 undergoing midline mandibulotomy for tumors of the oral cavity ( 7 patients) and oropharynx (23 patients) were retrospectively reviewed. Thr ee patients presented with recurrent disease, 1 of whom was previously irra diated. Twenty-five patients received postoperative radiation after mandibu lotomy to a median dose of 60 Gy to the primary tumor bed, whereas 5 patien ts were treated with surgery alone. The patients were separated into those whose mandibulotomy site was within the radiation treatment field (n = 9), and those whose site was shielded (n = 10). Median follow-up was 27.8 month s (range 5-81 months). End points included significant pain involving the m andibulotomy site, trismus, malocclusion, wound infection, osteoradionecros is, and time to oral intake. Results: There were no postoperative deaths. Minor wound infection or break down occurred in 4/30 patients (13%). All of these resolved with local care and parenteral antibiotics. More serious complications involving the mandi bulotomy occurred in 2 patients (7%). One patient had chronic wound drainag e at the mandibular osteotomy site, which healed after plate removal. Anoth er patient developed osteoradionecrosis. No patient developed trismus or ma locclusion. With a median follow-up of 27.8 months, 4 patients have recurre d locally. The complication rate was 11% for patients whose mandibulotomy s ite was irradiated, and 30% for those whose site was shielded. Conclusion: Mandibulotomy can be safely performed in patients who are likel y to require postoperative external radiation.