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.
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.