Issue N# 2 - 2011
HEAD AND NECK CARCINOLOGY
Combined transoral and suprahyoid approach for oropharyngeal cancers: an alternative to mandibulotomy
Authors : Gallet P, Gangloff P, Mastronicola R, Cortese S, Phulpin B, Mecellem H, Kaminski MC, Guillet J, Dolivet G. (Nancy)
Ref. : Rev Laryngol Otol Rhinol. 2011;132,2:95-102.
Article published in english
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Surgical treatment of oropharyngeal tumours usually requires mandibular osteotomy. Using this technique allows a better exposure and an easier excision, but this approach often generates complications. Since 1995, we used a less aggressive surgical technique, with a suprahyoid pharyngotomy when the oral approach was not sufficient, thus sparing the mandible. Objective: The purpose of this study is to evaluate this technical evolution, ensuring that mandibular preservation doesn’t affect quality of exeresis, local control and survival, while allowing a lower complication rate. Material and methods: All patients who have had a surgical treatment for an oropharyngeal carcinoma between 1995 and 2001 in our center were included in this study. Results: Mandibular sparing was used for 55 patients; 19 patients underwent mandibulotomy. The surgical procedure’s quality was classified as clear, close, or insufficient margins. All adjuvant treatments were noted, functional and carcinologic results were evaluated. No significant differences are found for exeresis quality and local control. There are less complications (p= 0.045) and less surgical revisions (p= 0.023) in the preservation group. Survival and functional results are better in the preservation group, but without significant difference. For oropharyngeal tumours, survival is dependent on tumoural aggressivity, on general condition and co-morbidity and on the development of a second tumour. Results in local control rate (83.7% at 1 year) are satisfying compared to literature. Conclusion: Mandibular preservation is an efficient and safe procedure, even for T3/T4 tumours. Most of oropharyngeal tumours can be removed without mandibulotomy. The suprahyoid approach provides a good exposure when oral approach is insufficient, thus avoiding mandibulotomy and its complications.
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