Maxillectomy through mandibulotomy--a retrospective clinical review.

PURPOSE: To review retrospectively the benefits of using mandibulotomy as an access for tumors involving the maxilla and infratemporal fossa.

PATIENTS AND METHODS: Twenty-four consecutive patients with tumors involving the maxilla and infratemporal fossa underwent maxillectomy through mandibular access osteotomy. Patient details and postoperative follow-up were reviewed and recorded. Postoperative complications such as neural morbidity and problems relevant to the procedure were evaluated. Ethical clearance from the medical practices board of the hospital was not required for this study.

RESULTS: All but 1 patient underwent en bloc resection of the maxillary tumor with a histologically negative margin. One patient with adenoid cystic carcinoma had a positive orbital margin. Residual mouth opening smaller than 2.5 cm was observed in 4 patients. Healing of the osteotomy site was satisfactory in 21 patients. Three patients had osteotomy-related complications that required secondary intervention. Neural morbidity was temporary and cosmetic outcome of the procedure was excellent.

CONCLUSION: Mandibular access osteotomy is an acceptable approach to tumors involving the maxilla and infratemporal fossa. The advantages of wide exposure, minimal morbidity, and good cosmesis make it superior to the conventional panfacial approach. This article highlights the advantages of this procedure and discusses conventional approaches with review of the literature.