Treatment of oropharyngeal tumors

From WikiLectures

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:
  1. 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.
  2. 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]

related articles[edit | edit source]

Source[edit | edit source]

References[edit | edit source]