Böger D, Hartmann R, Sauer M
Klinik für Hals‑, Nasen- und Ohrenkrankheiten/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland.
Klinik für Mund‑, Kiefer- und Gesichtschirurgie/Plastische Operationen, SRH Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527, Suhl, Deutschland.
HNO. 2022 Feb;70(2):110-116. doi: 10.1007/s00106-021-01073-6. Epub 2021 Jun 25.
In the context of tumor surgery, the median mandibulotomy as an access route to the oral cavity and oropharynx provides an excellent overview of the surgical site. However, it is not regarded entirely unproblematic with regard to early and later complications that may arise.
The results and complications of the median mandibulotomy will be presented based on data collected from our own patient collective.
A total of 21 patients who had undergone a median mandibulotomy as part of tumor surgery at the Department of Otorhinolaryngology of the SRH Zentralklinikum Suhl were examined over a period from 01 January 2010 to 31 December 2020. The patient files were retrospectively evaluated.
A stair-step median mandibulotomy was performed in all 21 patients. Reconstruction was performed using a 2.8 mm thick angled mandibular plate and bicortical locking screws. The mean follow-up period was 29.8 months. In all, 7 patients (33%) had a recurrence at the time of surgery; 5 patients (24%) had already undergone pre-radiation. Furthermore, 18 patients (85.7%) received adjuvant radiotherapy. We found plate loosening or extrusion in 0 of 21 cases. A salivary fistula (4.7%) was observed in 1 patient. Trismus was found in 4 (19%) cases during follow-up. Osteoradionecrosis was found in 2 (9.5%) of 21 cases. Cosmetic deficits were not observed.
Our results show that the stair-step median mandibulotomy in combination with a 2.8 mm thick reconstruction plate and bicortical locking screws leads to a stable and safe reconstruction even with pre-irradiated situations. Plate loosening or extrusion did not occur.
在肿瘤手术中，正中下颌骨切开术作为进入口腔和口咽的一种途径，能提供极佳的手术视野。然而，就可能出现的早期和后期并发症而言，它并非完全没有问题。
将基于从我们自己的患者群体收集的数据，展示正中下颌骨切开术的结果和并发症。
对2010年1月1日至2020年12月31日期间在苏尔SRH中心医院耳鼻喉科接受肿瘤手术时进行了正中下颌骨切开术的21例患者进行了检查。对患者病历进行回顾性评估。
所有21例患者均进行了阶梯式正中下颌骨切开术。使用一块2.8毫米厚的成角下颌骨板和双皮质锁定螺钉进行重建。平均随访期为29.8个月。共有7例患者（33%）在手术时出现复发；5例患者（24%）已接受过放疗前治疗。此外，18例患者（85.7%）接受了辅助放疗。我们发现21例中0例出现钢板松动或脱出。1例患者出现涎瘘（4.7%）。随访期间发现4例（19%）出现牙关紧闭。21例中有2例（9.5%）出现放射性骨坏死。未观察到美容缺陷。
我们的结果表明，阶梯式正中下颌骨切开术结合一块2.8毫米厚的重建板和双皮质锁定螺钉，即使在放疗前的情况下也能实现稳定、安全的重建。未发生钢板松动或脱出。
