Transmandibular

Transmandibular refers to surgical approaches or procedures that pass through or involve the mandible to access structures of the jaw, oral cavity, pharynx, or skull base. The term is used mainly in maxillofacial and skull base surgery. In many transmandibular approaches, a controlled osteotomy of the mandible (a mandibulotomy) is performed to widen the surgical field; after the targeted work is completed, the mandible is realigned and rigidly fixed with plates and screws or wires.

Indications include tumors and lesions of the oropharynx, nasopharynx, parapharyngeal space, or skull base where traditional intraoral or transnasal routes provide limited exposure, as well as complex reconstructive cases requiring extensive access. Variants include midline, paramedian, or unilateral mandibulotomies, and different incisions such as lip-split or apron incisions to improve visualization, often combined with lateral maxillary or cranial approaches.

Advantages include markedly improved exposure, enabling en bloc resections and complex reconstruction; drawbacks include added surgical time, risk of malocclusion, mandible nonunion, infection, osteoradionecrosis in irradiated patients, dental injury, sensory deficits of the inferior alveolar nerve, and cosmetic concerns. Perioperative planning typically involves imaging, dental evaluation, and multidisciplinary coordination among otolaryngology, neurosurgery, and maxillofacial surgery, as well as consideration of functional rehabilitation.

The term also appears in dental and reconstructive contexts, but in skull base work it denotes an access route rather than a specific operation.