Treatment of oropharyngeal tumors

Surgery, radiotherapy and their combinations are used in the treatment of oropharyngeal tumors.

Oral approach

 * It is used for small, superficial, exophytic growing tumors, such as tongue, base of the tongue, palate, uvula or tonsils.
 * The tumor must be accessible from the mouth, it must not spread to the base.
 * CO2 laser is often used.

External access

 * It usually follows block dissection of the cervical nodes.
 * We have two types:
 * 1) Non- mandibular procedures
 * 2) * Pull through:
 * 3) ** it is a combined resection from the cervical and oral approach.
 * 4) * Procedures without resection of the mandible are performed on tumors of the base of the mouth and root of the tongue.
 * 5) * If the alveolar ridge is affected - a partial mandibulectomy is still performed;
 * 6) ** the segment of the protrusion is removed without breaking the arm of the mandible.
 * 7) * The resection is stretched into the cervical surgical wound and removed.
 * 8) * Lateral pharyngotomy:
 * 9) ** is used to treat tongue root tumors and tonsillar fossa;
 * 10) ** we penetrate the pharynx around the big corner of the tongue.
 * 11) * Medial pharyngotomy (suprahyoid):
 * 12) ** the second traditional procedure;
 * 13) ** we penetrate just above the tongue in the area of ​​glosoepiglottic valules;
 * 14) ** most often on small medially placed tumors of the root of the tongue.
 * 15)  Procedures violating the continuity of the mandible
 * 16) * All larger operations.
 * 17) * It is either a temporary strain followed by osteosynthesis or it is resected segmentally.
 * 18) * Temporal mandibulotomy (mandibular split):
 * 19) ** the biggest advantage is the clarity of the operating field;
 * 20) ** it can be medial or paramedial (via the foramen mentale) or lateral;
 * 21) ** good aesthetic result, but the mandible does not heal well with current radiotherapy.
 * 22) * The most radical approach:
 * 23) ** resection of the lateral segment of the mandible that is in contact with the tumor;
 * 24) ** in one block together with the soft tissues it is removed;
 * 25) ** the jaw slides to the operated side - the occlusion is imperfect, bad chewing;
 * 26) ** Mandibular bone reconstruction is usually not performed, it does not help functionally.
 * 27) * Medial segment resection:
 * 28) ** in large tumors of the base;
 * 29) ** catastrophic aesthetic and functional results → bone reconstruction is done, usually from the fibula.

Therapy of nodal metastases

 * Part of the treatment of every oropharyngeal tumor.
 * Surgically, it is always a block dissection.
 * Usually supraomohyoid (NO I to III);
 * we will remove it and in case of a positive finding we will complete the complete block dissection.

related articles

 * Oropharyngeal tumors
 * Epipharyngeal tumors

Source

 * ws:Léčba nádorů orofaryngu
 * ws:Léčba nádorů orofaryngu