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

OBJECTIVES/HYPOTHESIS: 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. STUDY DESIGN: Five experimental procedures were performed on five cadavers. METHODS: 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. RESULTS: An increase in retractor opening, transoral exposure, and oral cavity was observed in all specimens. CONCLUSIONS: Mandibular osteotomies increase exposure to oral cavity and oropharyngeal lesions in the setting of TORS.