Double mandibular osteotomy technique with inferior alveolar neurovascular bundle preservation for improved access to tumors of the parapharyngeal space

The parapharyngeal space harbors 0.5% of all head and neck neoplasms. The surgical approach is the primary difficulty during these tumors resection once superiorly the access becomes more restricted by the progressive encroachment of the mastoid process and the angle of the mandible. Different types of mandibulotomy performed to improve the access to the parapharyngeal space are described in the literature. The aim of this work is to describe the technique used during parapharyngeal space neoplasms resection when a wider access is necessary. The technique is a pre-mental foramen mandibulotomy combined with a ramus osteotomy, which allows the mandibular body segment to be rotated completely out of the operative field. After the tumor resection the mandibular segment is reduced and its fixation is made with 2.0 and 2.4 plates and screws systems. The double mandibulotomy not only provides a wider field but also protects the inferior alveolar neurovascular bundle, which remains completely contained into the osteotomized mandibular segment. This technique dispenses the use of the intermaxillary fixation and provides to the patient postoperative early mandibular function and inferior alveolar neurovascular bundle vitality, with no hypoesthesia of this nerve in the postoperative.

Conflict of interest: None declared.

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Feb 5, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Double mandibular osteotomy technique with inferior alveolar neurovascular bundle preservation for improved access to tumors of the parapharyngeal space
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