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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Rivista Italiana di Chirurgia Maxillo-Facciale 2001 April;12(1):63-73
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
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.