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Rivista Italiana di Chirurgia Maxillo-Facciale 2001 April;12(1):63-73

language: English

Why split the lip in transmandibular resection?

Cantù G., Pizzi N., Riccio S., Barberi F., Bimbi G., Squadrelli M., Mattavelli F.

From ­the National Institute ­for ­the Study and Treatment of Cancer, Milan Department of Head ­and Neck Surgery Cranio-Maxillo-Facial Surgery Unit


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Background. Transmandibular resec­tion (Comman-do), man­dib­u­lar ­swing ­approach ­and ­pull-­through ­approach ­are ­the fun­da­men­tal tech­niques ­for ­oral ­and oroph­a­ryn­geal ­large ­tumor resec­tion. Hayes Martin ­was ­one of ­the ­first ­who pre­sent­ed ­the ­block resec­tion of ­the man­dible ­and cer­vi­cal ­nodes in 1951. He ­wrote: “After com­ple­tion of ­the ­neck dis­sec­tion... ­the ­lip ­and ­chin ­are ­split in ­the ­mid-­line ­and ­the ­cheek reflect­ed lat­er­al­ly”. From ­then on ­almost ­all ­authors ­took ­for grant­ed ­the ­lip split­ting. But Ward, in 1951, pre­sent­ed ­the ­same tech­nique with­out ­lip split­ting.
Methods. From 1980 ­and 1999 at ­the National Cancer Institute 345 ­patients ­have ­been treat­ed ­for ­oral ­and oroph­a­ryn­geal ­tumors, per­form­ing 290 trans­man­dib­u­lar resec­tions, 42 ­swing resec­tions ­and 13 ­pull-­throughs.
Results. In 18 cas­es we resect­ed ­also a por­tion of ­chin or ­cheek ­skin, pos­sibly pre­serv­ing ­the ­lip con­tour. A ­mono or bilat­er­al ­bloc ­neck dis­sec­tion ­was ­always per­formed ­except in cas­es of ­relapse ­after a sur­gi­cal treat­ment ­with ­neck dis­sec­tion. We ­repaired 293 ­patients ­with ­flaps (271 ped­i­cled ­and 22 ­free ­flaps). We recon­struct­ed ­the man­dible in 34 cas­es. The ­lip pres­er­va­tion nev­er com­pli­cat­ed resec­tion ­and recon­struc­tion. Furthermore ­the pro­ce­dure is ­time spar­ing, as we avoid­ed ­the hae­mos­ta­sis ­and ­the ­suture of ­the ­lip. The cos­met­ic ­and func­tion­al ­results ­were, obvi­ous­ly, bet­ter ­than ­those ­obtained by tra­di­tion­al tech­niques.
Conclusions. We ­can con­clude ­that ­the ­lip split­ting in trans­man­dib­u­lar resec­tion ­for ­oral ­and oroph­a­ryn­geal ­tumors is ­almost ­always use­less.

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