Head and neck cancer is neurotrophic and nearly 30% of cases appear to have nerve
involvement.
1
Segmental mandibulectomy is the treatment of choice in head and neck cancer cases
that have evident or possible involvement of the inferior alveolar nerve.
2
We suggest that the posterior osteotomy in this procedure should be performed as
a unilateral sagittal split osteotomy. This technique allows the surgeon to not only
follow the nerve to the base of the skull but also to cut with the handpiece away
from the nerve. In the standard technique the surgeon performs the osteotomy in the
region of the third molar, cutting the nerve inside the mandibular canal. We suggest
that it is better to perform the unilateral sagittal split osteotomy after a lower
lip split and anterior osteotomy. In this manner the surgeon can have a better view
of the sagittal osteotomy, keeping the cutting instruments away from the mandibular
canal and leave behind less cortical bone in the remaining mandible (than the typical
Bilateral Sagital Split Osteotomy BSSO). This technique should not be performed when
the tumour is close to the outer cortical surface of the mandible in the region of
the third or second molar. In this case the surgeon can perform the osteotomy cranially
to the mandibular foramen.Keywords
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References
- Perineural invasion as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis.Acta Otolaryngol. 2019; 139: 1038-1043
- Perineural invasion in oral squamous cell carcinoma: incidence, prognostic impact and molecular insight.J Oral Pathol Med. 2020; 49: 994-1003
Article Info
Publication History
Published online: April 26, 2022
Accepted:
April 19,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
