Mandibulotomy (approach)

Considerations

• • Anatomy

    • Mandible thickness (2002: Mandibular Thickness Measurements in Young Dentate Adults), mean (SD)

      • symphysis 

        • 14.03 (1.53) mm for men

        • 13.21 (1.46) mm for women

      • halfway between the symphysis and the mental nerve

        • 11.17 (1.37) mm for men

        • 10.00 (1.08) mm for women

  • Range of approaches to the oropharynx 

    • Transoral

      • True Transoral

      • Mandibulotomy

      • Mandibulectomy

    • Transcervical

      • Pull-through

      • Pharyngotomy

      • Laryngotomy

      • Laryngectomy

    • Combinations

  • Incision style 

    • Dr. W prefers midline straight skin incision and paramedian straight vertical osteotomy through root of either central or lateral incisor 

    • In the neck, continue the midline mental skin incision into the midline neck and either curve into a neck crease or turn into the neck crease at a right angle 

Preparation

Procedure

Sample operative report

Post-op

• • CPT codes

    • 21198 - 

Pearls & Pitfalls

High-Yield

Links

• UTMB - Surgical Approaches to the Oropharynx

• Iowa protocols - Lip Split With Mandibulotomy Approach

• OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY - RESECTION OF CANCERS OF THE BASE OF TONGUE