Replacement of lip-split mandibulotomy by pull-through approach for T3–4 oral carcinomas. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Marhic, A.; Guerlain, J.; Benmoussa, N.; Breuskin, I.; Honart, J.-F.; Janot, F.; Moya-Plana, A.; Temam, S.; Gorphe, P.
• Is Part Of: International journal of oral & maxillofacial surgery. Volume 50:Issue 9(2021)
• Page Start: 1123
• Page End: 1130
• Publication Date: 2021-09
• Subjects: Mouth neoplasms -- Tongue neoplasms -- Mandibular osteotomy -- Postoperative complications -- Health-related quality of life; Mouth -- Surgery -- Periodicals; Maxilla -- Surgery -- Periodicals; Dentistry -- Periodicals; Dentistry, Operative; Oral Surgical Procedures; Surgery, Oral; Dentistry; Maxilla -- Surgery; Mouth -- Surgery; Electronic journals; Periodicals; 617.52059
• DOI: 10.1016/j.ijom.2020.10.011
• Languages: English
• ISSNs: 0901-5027

Abstract

Abstract: At the study hospital, the lip-split mandibulotomy (LSM) has progressively been replaced by a pull-through (PT) approach. This study compared the outcomes of the LSM and PT approaches in a series of 192 patients with T3–T4a oral tongue and floor of the mouth squamous cell carcinoma treated over the two last decades. No difference in margin status ( P = 0.254), rate of early complications (local infections) ( P = 0.867), haematoma/haemorrhage ( P = 0.221), delayed wound healing ( P = 0.438), re-operation ( P = 0.083), or Clavien–Dindo classification (P= 0.5281) was found. The LSM approach was associated with a higher rate of late complications such as pseudarthrosis (14.5% vs 0.9%; OR 17.89, P = 0.0005) and trismus (35% vs 13.8%; OR 3.32, P = 0.025), and a trend towards a higher rate of fistulas (24.6% vs 13.1%; OR 2.16, P = 0.088). The quality of life of long-term survivors (median 132 months) was similar in the two groups, with a mean QLQC30 score of 59.7 ( P = 0.099) and mean MDADI score of 57.4 ( P = 0.213). The 5-year local control rate was 86.4% in the PT group and 86.2% in the LSM group ( P = 0.878), while the 5-year overall survival rates were 50.0% and 48.3%, respectively ( P = 0.68). In our experience, replacement of LSM by a PT approach in oral carcinoma was associated with decreased rates of late complications such as pseudarthrosis, fistula, and trismus, without any difference in oncological outcomes.