Journal of Medicine Vol 4 - Amrita Institute of Medical Sciences and ...

Amrita Journal of Medicine
Extended Maxillectomy by Transmandibular Approach
mandibulotomy over a median mandibulotomy are well
established.
Conclusion: Mandibulotomy is the approach of choice
for maxillary tumors with posterior extension. It gives
good access for the clearance of the infratemporal fossa.
It can be combined with other approaches as required
depending on the extent of tumor. The cosmesis is good
with reconstruction of the maxillectomy defects and the
morbidity of the approach is minimal.
Fig.8: Mandibulotomy combined with Weber Ferguson
approach
REFERENCES
1. Qureshi SS, Chaukar DA, Talole SD, et al. Squamous cell carcinoma
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Fig.9: Mandibulotomy combined with bicoronal incision
for craniotomy
the neck. Para pharyngeal space, infratemporal fossa, clivus,
nasopharynx and cervical spine can be exposed by
this approach. Local recurrence due to inadequate posterior
clearance in maxillary sinus cancers was well
documented and various approaches were described to
approach the infratemporal and retro maxillary regions.
However they suffer from drawbacks of lateral mandibular
osteotomy or limited exposure. Lawson et al for the
first time in 1990 reported combined median
mandibulotomy and Weber- Ferguson approach for total
maxillectomy for the purpose of enbloc resection of pterygoid
plates and infratemporal fossa muscles along with
the maxillectomy specimen 15 . Again, no other reports of
such approach are found in the literature after that. In
2001, R. M. Tiwari described the transmandibular approach
to total maxillectomy. He advocated a paramedian
mandibulotomy and the anteromedial dissection could
be through the upper sub labial extension of the same
approach 11 . Other incisions can be added as necessary.
As described by the same author, clearance of the retro
maxillary area enbloc with the maxilla is the single most
advantage of the technique. In addition to this, a Weber-
Ferguson incision can be totally avoided in many instances.
However, other approaches can be combined with
this approach if necessary as shown in our series. Trismus
is a common sequel but this is not related only to
the approach because any surgery involving the infratemporal
fossa results in trismus. Advantages of a Para-median
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