Healing of Temporary Mandibulotomy underConditions of Postoperative Radiotherapy

Czech version

Authors: J. Klozar; J. Kastner; M. Taudy; A. Slavíček; T. Belšan
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK a FN Motol, Praha, katedra otorinolaryngologie IPVZ, Praha, přednosta a vedoucí katedry prof. MUDr. J. Betka, DrSc. Klinika zobrazovacích metod 2. LF UK a FN Motol, Praha, přednosta doc. MUDr.
Published in: Otorinolaryngol Foniatr, , 2001, No. 2, pp. 81-85.
Category:

Overview

Lateral temporary mandibulotomy (mandibular swing, mandibular split) is a very favou-rable approach in surgical treatment of oropharyngeal carcinoma. Frequent complications in thehealing of osteosynthesis during postoperative radiotherapy limit to some extent successful use ofthis procedure. In our retrospective study we investigate the incidence of these complications andlook for the risk factors connected with such unfavourable development.Out of 203 patients treated by surgery in a period of 4.5 years lateral temporary mandibulotomywas used in 31 patients (15%). Twenty-nine of them were postoperatively irradiated. Logisticregression was used for analyzing the relation of healing of osteosynthesis and the age of the patient,the location of the tumour, the classification T and N, the surgeon, the interval between theoperation and the beginning of radiotherapy, the dose of radiation and to oncological outcome 12months after the treatment in these 29 patients.A complication of healing of the mandible developed in 12 patients during the 12 months after thecompletion of therapy. In 2 patients only intraoral denudation of the plate occurred and in 10patients a fistula developed.All patients with complicated healing were treated in the first place conservatively by antibiotics,which led in one half of the cases to healing. Surgical intervention was necessary in 6 cases, in threecases out of six segmental mandibulotomy was inevitable (10% of the whole group). Risk factors forthe delayed healing of the mandibular osteotomy were not discovered, the age of the patients wasof all parameters the closest to significance.Despite a higher complication rate we consider temporary mandibulotomy indicated even in caseof planned postoperative radiotherapy. More careful indication of this approach in elderly patientsis advisable.

Key words:
oropharyngeal carcinoma, surgery, postoperative radiotherapy, temporary mandibulotomy, complication, osteoradionecrosis.

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