A comparison of aesthetic, functional and patient subjective outcomes following lip-split mandibulotomy and mandibular lingual releasing access procedures

Good access to the site of oral cancer is essential to allow for adequate t hree-dimensional resection of the tumour. Splitting the lower lip in conjun ction with a mandibulotomy offers excellent access to all areas of the mout h and pharynx, but this inevitably produces a facial scar and there is morb idity associated with the healing of the mandibulotomy. An alternative appr oach is the mandibular lingual releasing technique, which provides good acc ess to the oral cavity and avoids the morbidity associated with lip-split m andibulotomy. The aim of this study was to compare aesthetic, functional an d patient subjective outcomes between the two access procedures. One hundre d and fifty patients had oral access procedures between 1992-95 (ninety lip -split mandibulotomy and sixty mandibular lingual release). Thirty patients fulfilled selection criteria (primary surgery as treatment, tumour size <5 .1 cm, anterior oral cavity tumours, and reconstructed with a radial forear m free flap) and 10 patients from each group were able to attend a review a ppointment for objective clinical assessment of their speech, tongue mobili ty, lip competence and temperomandibular signs. Using items from the Univer sity of Washington quality of life questionnaire patient subjective outcome s were assessed. Using standardised photographs the clinician and lay perso ns assessed the overall post-operative facial appearance. The patients also assessed their own facial appearance using a similar scoring method. Resec tion margins were similar in both groups and it would seem that both method s provide adequate access to the anterior oral cavity. Clinical examination showed no differences in function between the two access procedures. Altho ugh there was a small number, the lip-split mandibulotomy group reported si gnificantly better speech, swallowing and chewing. Previous concerns about a possible detrimental effect on appearance following lip-split, were not b orne out in this study.