Division of Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville.
Division of Neuroradiology, Department of Radiology, University of Virginia Health System, Charlottesville.
JAMA Otolaryngol Head Neck Surg. 2014 Dec;140(12):1184-90. doi: 10.1001/jamaoto.2014.2005.
Midline mandibulotomy is a common approach for resection of head and neck oral cavity and oropharyngeal tumors; however, there are limited data available on the outcomes of lag screw vs plate fixation.
To compare outcomes for midline mandibulotomy open reduction and internal fixation using plates vs lag screw technique.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study at a tertiary care academic medical center of patients undergoing midline mandibulotomy for head and neck tumor resection over a 6-year period.
Mandibular fixation using lag screws or plates.
The medical records and computed tomographic (CT) scans of patients undergoing midline mandibulotomy for head and neck tumor resection over a 6-year period were retrospectively reviewed. The postoperative CT scans were reviewed by a neuroradiologist who graded the fusion site on a scale of 0 to 2 using a 2-pass method. The rates and grades of union were compared, as well as several factors that affect healing, for fixations performed with plates vs lag screws.
Thirty-seven patients were included. The overall rate of radiologic union was 90% (9 out of 10) for lag screw technique and 41% (11 out of 27) for plates (P = .01). The average grade of radiologic union was 1.3 for lag screws and 0.67 for plates (P = .04). Hardware exposure occurred in 4 (15%) of the plate group and fistulae formed in 3 (11%); neither complication occurred in the lag screw group. In univariate analysis, both presence of dentition (odds ratio [OR], 5.50 [95% CI, 1.33-22.73]; P = .02) and plate technique (OR, 13.09 [95% CI, 1.45-11.62]; P = .02) were significantly associated with nonunion. In multivariate analysis, plate technique had an OR of 8.32 (95% CI, 0.85-81.75) for nonunion (P = .07).
Fixation of midline mandibulotomy with lag screws results in a significantly increased rate of radiologic union compared with plates. Lag screws were also significantly better at achieving radiologic union in patients who underwent postoperative radiation, and the rates of fistula formation and hardware exposure were lower. Thus, lag screw fixation of midline mandibulotomy should be considered an excellent option, especially when patients will undergo postoperative adjuvant therapy and in patients at high risk for wound complications.
经中线下颌切开术是切除头颈部口腔和口咽肿瘤的常用方法；然而，关于使用螺钉与接骨板固定的结果的数据有限。
比较使用接骨板与螺钉技术行中线下颌切开术复位内固定的结果。
设计、地点和参与者：对一家三级保健学术医疗中心的患者进行了回顾性队列研究，这些患者在 6 年内因头颈部肿瘤切除而行中线下颌切开术。
使用螺钉或接骨板进行下颌固定。
对 6 年内因头颈部肿瘤切除而行中线下颌切开术的患者的病历和计算机断层扫描（CT）进行了回顾性审查。由神经放射科医生对术后 CT 扫描进行了双盲评分，采用 2 次通过法对融合部位进行 0 至 2 分的评分。比较了使用接骨板与螺钉固定的愈合率和等级，以及影响愈合的几个因素。
共纳入 37 例患者。螺钉技术的影像学总愈合率为 90%（10 例中的 9 例），而接骨板的愈合率为 41%（27 例中的 11 例）（P = .01）。螺钉技术的影像学平均愈合等级为 1.3，而接骨板的为 0.67（P = .04）。接骨板组有 4 例（15%）出现了内置物暴露，3 例（11%）出现了瘘管；螺钉组均未出现这些并发症。在单变量分析中，有牙列（比值比[OR]，5.50[95%CI，1.33-22.73]；P = .02）和接骨板技术（OR，13.09[95%CI，1.45-11.62]；P = .02）这两个因素与不愈合显著相关。在多变量分析中，接骨板技术的非愈合比值比（OR）为 8.32（95%CI，0.85-81.75）（P = .07）。
与接骨板相比，使用螺钉固定中线下颌切开术可显著提高影像学愈合率。螺钉在接受术后放疗的患者中更能实现影像学愈合，且瘘管形成和内置物暴露的发生率更低。因此，应考虑使用螺钉固定作为中线下颌切开术的一种极佳选择，尤其是在患者将接受术后辅助治疗和有伤口并发症高风险的情况下。
