Mandibular swing approach: 25 years of experience at Istituto Nazionale Tumori of Milan

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2025-05-30 DOI:10.1016/j.oraloncology.2025.107405

Marco Guzzo , Roberto Bianchi , Sarah Colombo , Filippo Santamato , Salvatore Alfieri , Nicola Alessandro Iacovelli , Giovanni Felisati , Laura Gagliardini

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引用次数: 0

Abstract

Between 1997 and 2022, 108 patients underwent the lip-splitting mandibulotomy approach (LSMA) as part of the surgical treatment for oral (49 patients) and oropharyngeal (59) tumors. Seventy-two tumors were primary, and 36 were recurrent/persistent; the most common histology was squamous cell carcinoma (99). Immediate reconstruction of the defect was performed using free flaps (72), pectoralis major musculocutaneous pedicled flaps (32), and local flaps (4).

Margin status was assessed in all cases; free margins were achieved in 78 patients (72 %), while 30 patients (28 %) had positive or close margins. For primary tumors, margins were free in 76 %, whereas in the recurrent-persistent group the percentage dropped to 64 %.

Most patients (82) received radiotherapy.

Fifty patients experienced one or more postoperative complications, most of them in patients who received radiotherapy (41 out of 82 patients, 50 %), compared to 9 out of 26 patients (35 %) who did not undergo radiotherapy.

Bone-related complications occurred 15 times, all in patients who had undergone radiotherapy; postoperative fistulas were observed in 18 patients, with 7 having received preoperative radiotherapy.

After an average follow-up of 51 months (range 2–274 months), 54 out of 99 patients (54 %) were alive without disease, while 38 (38 %) died of cancer. The 4-year overall survival rates for patients with oral and oropharyngeal cancers were 47 % and 36 %, respectively.

In conclusion, LSMA can be recommended in cases of advanced neoplasms, where the best outcomes are achievable only if the tumor can be resected with clear margins and the resulting defect can be effectively reconstructed.

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下颌摆动入路：米兰国立肿瘤研究所25年经验

1997年至2022年间，108例患者接受了唇裂下颌骨切开术（LSMA）作为口腔（49例）和口咽（59例）肿瘤手术治疗的一部分。72例为原发肿瘤，36例为复发/持续性肿瘤；最常见的组织学为鳞状细胞癌（99）。采用自由皮瓣（72例）、胸大肌皮带蒂皮瓣（32例）和局部皮瓣（4例）对缺损进行即时重建。在所有情况下都评估了边际状况；78例患者（72%）获得游离边缘，30例患者（28%）获得阳性或闭合边缘。对于原发肿瘤，76%的边缘是游离的，而在复发持续性组中，这一比例下降到64%。大多数患者（82例）接受放疗。50例患者出现一种或多种术后并发症，其中大多数发生在接受放疗的患者中（82例患者中有41例，50%），而26例未接受放疗的患者中有9例（35%）。发生骨相关并发症15次，均为放疗患者；术后观察到18例瘘管，其中7例术前接受放疗。平均随访51个月（2-274个月）后，99例患者中54例（54%）存活无病，38例（38%）死于癌症。口腔癌和口咽癌患者的4年总生存率分别为47%和36%。综上所述，对于晚期肿瘤，LSMA是可以推荐的，只有切除肿瘤边界清晰，并能有效重建肿瘤缺损，才能达到最佳效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.