Healing of Temporary Mandibulotomy under
Conditions of Postoperative Radiotherapy
Klozar J., Kastner J., Taudy M., Slavíček A., Belšán T.
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. J. Neuwirth, CSc. |
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Summary:
Lateral temporary mandibulotomy (mandibular swing, mandibular split) is a very favou-
rable approach in surgical treatment of oropharyngeal carcinoma. Frequent complications in the
healing of osteosynthesis during postoperative radiotherapy limit to some extent successful use of
this procedure. In our retrospective study we investigate the incidence of these complications and
look 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 mandibulotomy
was used in 31 patients (15%). Twenty-nine of them were postoperatively irradiated. Logistic
regression 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 the
operation and the beginning of radiotherapy, the dose of radiation and to oncological outcome 12
months after the treatment in these 29 patients.
A complication of healing of the mandible developed in 12 patients during the 12 months after the
completion of therapy. In 2 patients only intraoral denudation of the plate occurred and in 10
patients 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 three
cases out of six segmental mandibulotomy was inevitable (10% of the whole group). Risk factors for
the delayed healing of the mandibular osteotomy were not discovered, the age of the patients was
of all parameters the closest to significance.
Despite a higher complication rate we consider temporary mandibulotomy indicated even in case
of planned postoperative radiotherapy. More careful indication of this approach in elderly patients
is advisable.
Key words:
oropharyngeal carcinoma, surgery, postoperative radiotherapy, temporary mandibulotomy, complication, osteoradionecrosis.
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