TECHNICAL NOTES   

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

Copyright © 2002 EDIZIONI MINERVA MEDICA

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

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.