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Unilateral saggital split osteotomy – A technical note for treating oral cancer

      Head and neck cancer is neurotrophic and nearly 30% of cases appear to have nerve involvement.
      • Zhu J.
      • Zhou R.
      • Wang Y.
      • et al.
      Perineural invasion as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis.
      Segmental mandibulectomy is the treatment of choice in head and neck cancer cases that have evident or possible involvement of the inferior alveolar nerve.
      • Alkhadar H.
      • Macluskey M.
      • White S.
      • et al.
      Perineural invasion in oral squamous cell carcinoma: incidence, prognostic impact and molecular insight.
      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.

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      References

        • Zhu J.
        • Zhou R.
        • Wang Y.
        • et al.
        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
        • Alkhadar H.
        • Macluskey M.
        • White S.
        • et al.
        Perineural invasion in oral squamous cell carcinoma: incidence, prognostic impact and molecular insight.
        J Oral Pathol Med. 2020; 49: 994-1003