The median mandibulotomy approach for head and neck tumors

Background: Histologically proven radical resections are the goal in patients with head and neck cancer because of improved survival rates. The frequency of histologically radical resections using the median mandibulotomy and the morbidity of this approach for tumors of the oropharynx and the parapharyngeal space are described in a patients series. Methods: The follow-up includes 16 consecutive patients who were operated on by a median mandibulotomy approach between 1995 and 1998. The oncological benefit ( tumor free margins), complications and the functional results (ability of opening the mouth, mastication, swallowing, speech, cosmesis and pain) were reviewed. Results: In 15/16 cases a histological radical resection was achieved. 14 patients were irradiated postoperatively. In this group 3 patients had an osteoradionecrosis, one an osteomyelitis of the mandible. The functional results were worse in more advanced tumors. Conclusion: The indications for a median mandibulotomy are primarily T3 and T4 tumors of the oral cavity and oropharynx, rarely expansive benign parapharyngeal tumors. In most cases a histological radical resection is achieved even in advanced tumors, probably due to the wide exposure of the involved area. in contrast this approach is associated with a high morbidity.