Mandibular osteotomy for expanded transoral robotic surgery: a novel technique.

Abstract

Transoral Robotic Surgery (TORS) has revolutionized the surgical treatment of malignant lesions of the oropharyngeal region. Recent studies have shown that this approach is a very safe procedure and can provide favorable clinical and functional outcomes with respect to traditional approaches. However, a small minority of patients who present with lesions amenable to TORS resection may not be candidates due to anatomical access issues. Anatomic features such as a retrognathic mandible, macroglossia, trismus, dentition, and small oral aperture limit the ability to perform TORS with current technology. We propose a modified TORS approach in which transoral mandibular osteotomies are performed that can greatly improve exposure to oropharyngeal subsites and expand access to the larynx in selected patients. Five experimental procedures were performed on five cadavers. Five cadavers were obtained for the investigation. Measurements including retractor opening, lateral cephalography, acoustic pharyngometry, and high-resolution photographs were taken prior to mandibular osteotomies and then repeated following the osteotomies. An increase in retractor opening, transoral exposure, and oral cavity was observed in all specimens. Mandibular osteotomies increase exposure to oral cavity and oropharyngeal lesions in the setting of TORS.