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9  Imaging of Orthognathic, Maxillofacial, and Temporomandibular Joint Surgery

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9.9\ Mandibulotomy

9.9.1\ Discussion

The transcervical and transcervical-parotid approaches are routinely performed to resect tumors of the parapharyngeal space. Occasionally, the wider exposure necessary for large or malignant tumors can be provided by midline or parasymphyseal mandibulotomy (Fig. 9.20). An additional mandibular ramus osteotomy, or “double osteotomy,”­ can be performed if additional exposure is required. These maneuvers allow for complete tumor resection without significant disruption of dentition, sensation, or occlusion.

Fig. 9.18  Open reduction and internal fixation and maxillomandibular fixation. 3D CT image shows plate and screw fixation of a mandible body fracture. Bilateral displaced subcondylar fractures are also present without hardware fixation

Fig. 9.19  External fixation of comminuted mandible fractures. Frontal radiographic image shows the external fixation device in position. Numerous other facial fractures treated via internal fixation and scattered metallic debris are also noted, which represent bullet fragments from a self-inflicted gunshot wound

Fig. 9.20  Parasymphyseal mandibulotomy. The patient is status post tongue base carcinoma resection. Mandibulotomy was performed to gain access to the lesion. Coronal CT image shows a parasagittal defect in the body of the mandible (arrow), which is otherwise fixed via metal plate and screws