13 Access Osteotomy

Mandibular access osteotomy allows mobilization of craniofacial skeleton and replacements of bony fragments either pedicled on their soft tissues or as free bone segments. This provides increased and direct exposure of posterior region and surrounding vital structures and avoid the need to resect uninvolved structures. Roux in 1836 suggested the division of the lower lip and mandible for improved access to the tongue carcinoma.In this paper we review various circumstances like tumors of posterior one third of tongue , tumors of infra temporal fossa and parapharyngeal tumors where access osteotomy was thought to be the preferred choice of treatment because of lack of adequate access to the surgical site. 1 2 Madhumati Singh, Auric Bhattacharya Professor & Hod, Department of Oral & Maxillofacial Surgery Rajarajeswari Dental College & Hospital, Bangalore, Karnataka Post Graduate, Department of Oral & Maxillofacial Surgery Rajarajeswari Dental College & Hospital, Bangalore, Karnataka INTRODUCTION : The optimum access to the site of malignancy of the oral cavity and oropharynx is imperative to allow threedimensional assessment and resection of the lesion. Incomplete surgical resection or rupture, due to poor access, predispose to tumor recurrence. Transoral resection is often possible for anterior tumours, but for posterior tumors an access osteotomy is required.Roux's 1836 description of division of the lower lip and mandible for improved access to the tongue carcinoma has often been cited as the original description for access osteotomy. Various methods have been described and splitting the lip in conjunction with an access osteotomy of the mandible has become the gold standard. ACCESS OSTEOTOMY: Access osteotomy was first introduced in 1836 by Roux to improve access in floor of mouth and base of tongue of tongue surgeries.It was repeated in 1959 by Head and neck oncology group of SloanKettering Cancer Hospital.In 1981, Spiro et al proposed the translabial access with mandibulotomy. In 1984, Attia et al described translabial access with mandibular osteotomy anterior to mental foramen, thus preserving the ipsilateral lip sensation. Access osteotomy is indicted in areas were the visualization and access is a challenge to the surgeon, specially in such areas were the access is hindered by other anatomical structures of the region.Access osteotomy is mainly indicated in areas like tumors of posterior floor of mouth ,base of tongue, ,nasopharynx ,oropharynx, parapharyngeal space &