Preservation of the mandibular arch in the floor of the mouth carcinoma employing a temporary pharyngostome

The Creation of a temporary pharyngo-cutaneous fistula is advocated as an adjunct in the surgical management of extensive floor of the mouth carcinomas, enabling preservation of the mandibular arch. The mandible sparing procedure is graphically outlined and is recommended for large floor of the mouth carcinomas which do not intimately involve the mandibular periosteum. This procedure renders a highly satisfactory cosmetic result in the treatment of a difficult lesion. The surgical management of carcinoma of the anterior floor of the mouth often presents an imposing problem. Frequently mandibular resection is an integral part of the procedure, eventuating in a profound cosmetic deformity. Procedures to preserve continuity of the mandibular arch are rarely employed for fear of leaving a residual tumor in the periosteum. Marchetta et al. (1971) have recently demonstrated that when the periosteum is not directly involved by tumor, the surgical excision can lead to preservation of the outer cortex and its periosteum. Mandibular prostheses, i.e. particulate bone grafts, cortical bone grafts and inert or acrylic metal struts or arches are utilised and offer varying degrees of success. There is an acknowledged high level of failure secondary to infection and rejection. Certainly none of these procedures offers entirely predictable results. Resection of the floor of the mouth in continuity with the inner table of the anterior body of the mandible (as outlined by Novak, 1969), preserves the normal configuration of the jaw and thus the overall appearance. A pre-requisite to this procedure is the creation of a temporary pharyngo-cutaneous fistula which permits diversion of the salivary flow away from the intraoral suture lines. Closure of the fistula after revascularization of the mandible reconstitutes the functional integrity and appearance of the patient.