Eisen M D, Weinstein G S, Chalian A, Machtay M, Kent K, Coia L R, Weber R S
Department of Otorhinolaryngology--Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, USA.
Am J Otolaryngol. 2000 Sep-Oct;21(5):312-7. doi: 10.1053/ajot.2000.9870.
To assess the morbidity of mandibulotomy in patients treated for neoplasms of the oropharynx and oral cavity, and to determine if postoperative radiation therapy to the mandibulotomy site carries an increased risk of complications.
The medical charts of 30 patients treated between 1992 and 1996 undergoing midline mandibulotomy for tumors of the oral cavity (7 patients) and oropharynx (23 patients) were retrospectively reviewed. Three patients presented with recurrent disease, 1 of whom was previously irradiated. Twenty-five patients received postoperative radiation after mandibulotomy to a median dose of 60 Gy to the primary tumor bed, whereas 5 patients were treated with surgery alone. The patients were separated into those whose mandibulotomy site was within the radiation treatment field (n = 9), and those whose site was shielded (n = 10). Median follow-up was 27.8 months (range 5-81 months). End points included significant pain involving the mandibulotomy site, trismus, malocclusion, wound infection, osteoradionecrosis, and time to oral intake.
There were no postoperative deaths. Minor wound infection or breakdown occurred in 4/30 patients (13%). All of these resolved with local care and parenteral antibiotics. More serious complications involving the mandibulotomy occurred in 2 patients (7%). One patient had chronic wound drainage at the mandibular osteotomy site, which healed after plate removal. Another patient developed osteoradionecrosis. No patient developed trismus or malocclusion. With a median follow-up of 27.8 months, 4 patients have recurred locally. The complication rate was 11% for patients whose mandibulotomy site was irradiated, and 30% for those whose site was shielded.
Mandibulotomy can be safely performed in patients who are likely to require postoperative external radiation.
评估接受口咽和口腔肿瘤治疗的患者行下颌骨切开术的发病率，并确定对下颌骨切开部位进行术后放射治疗是否会增加并发症风险。
回顾性分析1992年至1996年间接受中线下颌骨切开术治疗口腔肿瘤（7例）和口咽肿瘤（23例）的30例患者的病历。3例患者出现复发性疾病，其中1例曾接受过放疗。25例患者在接受下颌骨切开术后接受了术后放疗，原发肿瘤床的中位剂量为60 Gy，而5例患者仅接受手术治疗。患者被分为下颌骨切开部位位于放射治疗野内的患者（n = 9）和部位被屏蔽的患者（n = 10）。中位随访时间为27.8个月（范围5 - 81个月）。观察终点包括下颌骨切开部位的严重疼痛、牙关紧闭、咬合不正、伤口感染、放射性骨坏死以及恢复经口进食的时间。
无术后死亡病例。4/30例患者（13%）发生轻微伤口感染或裂开。所有这些情况通过局部护理和胃肠外抗生素治疗均得以解决。2例患者（7%）发生了涉及下颌骨切开术的更严重并发症。1例患者下颌骨截骨部位出现慢性伤口引流，在取出钢板后愈合。另1例患者发生了放射性骨坏死。无患者出现牙关紧闭或咬合不正。中位随访27.8个月时，4例患者出现局部复发。下颌骨切开部位接受放疗的患者并发症发生率为11%，部位被屏蔽的患者为30%。
对于可能需要术后外照射的患者，可以安全地进行下颌骨切开术。
