Mandibulotomies

Mandibulotomies are surgical procedures that involve cutting and temporarily dividing the mandible (lower jaw) to gain access to the oral cavity, oropharynx, base of the skull, or other adjacent structures. They are used mainly in maxillofacial and head and neck surgery for tumor resections, reconstruction, trauma management, and certain complex resections where alternative approaches provide insufficient exposure.

The two principal variants are midline sagittal (symphyseal) mandibulotomy and paramedian mandibulotomy. In a sagittal split, the mandible is divided along the chin region and the two halves are mobilized laterally to expose the surgical field. In a paramedian approach, the osteotomy runs just lateral to the midline in the parasymphysis or ramus region. Some cases employ a lip-splitting modification to improve access. After tumor removal or reconstruction, the mandible is reassembled and fixed with plates and screws, and soft tissues are closed.

Preoperative planning typically includes imaging and dental evaluation to map anatomy and protect structures such as the inferior alveolar nerve. Intraoperatively, precise osteotomy lines are planned to maximize exposure while preserving function. Reconstruction may involve vascularized free tissue transfer or other grafting techniques as indicated, with the mandible reanimated and stabilized to restore occlusion and form.

Complications can include malocclusion or instability at the osteotomy site, nonunion or fracture, infection, fistula formation, damage to the inferior alveolar nerve, tooth loss, and cosmetic deformity. With careful planning and reconstruction, mandibulotomies can provide excellent access for definitive treatment and acceptable functional outcomes, though recovery requires dental follow-up and adherence to healing guidelines.