AbstractBackgroundTumors involving the parapharyngeal space present a challenge of surgical access.MethodsWe reviewed all parapharyngeal space tumors resected at the University of California, San Francisco, between 2003 and 2006 and identified 14 patients who had a mandibular osteotomy to enhance surgical access to the parapharyngeal space.ResultsThe surgical approach for the 14 patients who had a mandibulotomy was accomplished via either 1 or 2 mandibular osteotomies. A single paramedian osteotomy between the canine and the first premolar was used in 4 cases, whereas a combination of a horizontal osteotomy above the lingula and a paramedian osteotomy between the canine and first premolar was employed in 8 cases. A lingual dental splint and rigid fixation were used to achieve mandibular stabilization and fixation.ConclusionWe found that the single and double mandibular osteotomies provided excellent surgical access allowing for total tumor removal with few sequelae. © 2008 Wiley Periodicals, Inc. Head Neck, 2009