Treatment of oropharyngeal tumors
Surgery, radiotherapy and their combinations are used in the treatment of oropharyngeal tumors.
Surgical approaches[edit | edit source]
Oral approach[edit | edit source]
- 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[edit | edit source]
- It usually follows block dissection of the cervical nodes.
- We have two types:
- Non- mandibular procedures
- Pull through:
- it is a combined resection from the cervical and oral approach.
- Procedures without resection of the mandible are performed on tumors of the base of the mouth and root of the tongue.
- If the alveolar ridge is affected - a partial mandibulectomy is still performed;
- the segment of the protrusion is removed without breaking the arm of the mandible.
- The resection is stretched into the cervical surgical wound and removed.
- Lateral pharyngotomy:
- is used to treat tongue root tumors and tonsillar fossa;
- we penetrate the pharynx around the big corner of the tongue.
- Medial pharyngotomy (suprahyoid):
- the second traditional procedure;
- we penetrate just above the tongue in the area of glosoepiglottic valules;
- most often on small medially placed tumors of the root of the tongue.
- Pull through:
- Procedures violating the continuity of the mandible
- All larger operations.
- It is either a temporary strain followed by osteosynthesis or it is resected segmentally.
- Temporal mandibulotomy (mandibular split):
- the biggest advantage is the clarity of the operating field;
- it can be medial or paramedial (via the foramen mentale) or lateral;
- good aesthetic result, but the mandible does not heal well with current radiotherapy.
- The most radical approach:
- resection of the lateral segment of the mandible that is in contact with the tumor;
- in one block together with the soft tissues it is removed;
- the jaw slides to the operated side - the occlusion is imperfect, bad chewing;
- Mandibular bone reconstruction is usually not performed, it does not help functionally.
- Medial segment resection:
- in large tumors of the base;
- catastrophic aesthetic and functional results → bone reconstruction is done, usually from the fibula.
Therapy of nodal metastases[edit | edit source]
- 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.
Links[edit | edit source]
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Source[edit | edit source]
- BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 14. 12. 2011]. <http://jirben2.chytrak.cz/materialy/orl_jb.doc>.