Treatment of tumors of the oropharynx
In the treatment of tumors of the oropharynx, surgery, radiotherapy and their combination are mainly used.
Surgical approaches[edit | edit source]
Oral approach[edit | edit source]
- It is used for small, superficial, exophytically growing tumors, such as the tongue, floor of the mouth, palate, uvula or tonsils.
- The tumor must be reachable from the mouth, it must not spread to the bottom.
- A CO 2 laser is often used.
External access[edit | edit source]
- As a rule, it follows a block dissection of the neck nodes.
- We have two types:
- Procedures not cutting the mandible
- Pull through:
- it is a combined resection from the neck and oral approach.
- Procedures without resection of the mandible are performed for tumors of the floor of the mouth and root of the tongue.
- If the alveolar process is affected - a partial mandibulectomy is also performed;
- is to extract a segment of the process without violating the mandibular shoulder.
- The resection is extended into the neck surgical wound and removed.
- Lateral pharyngotomy:
- is used for the treatment of tumors of the root of the tongue and tonsillar fossa;
- we penetrate the pharynx behind the big corner of the tongue.
- Medial pharyngotomy (suprahyoid):
- the second traditional procedure;
- we penetrate just above the tongue in the area of the glossoepiglottic valleculae;
- most often for small medially located tumors of the root of the tongue.
- Pull through:
- Procedures violating the continuity of the mandible
- All larger operations.
- Either it is a temporary resection with subsequent osteosynthesis or it is segmentally resected.
- Temporary mandibulotomy (mandibular split):
- the biggest advantage is the clarity of the operating field;
- may be medial or paramedian (through the foramen mentale) or lateral;
- good aesthetic result, but the mandible heals poorly with simultaneous 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 soft tissues are removed;
- the jaw moves to the operated side – the occlusion is imperfect, bad chewing;
- bone reconstruction of the mandible is usually not performed, it will not help functionally.
- Resection of the medial segment:
- in extensive base tumors;
- disastrous 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 tumor of the oropharynx.
- Surgically, it is always a block dissection.
- In N0 usually supraomohyoid (area I to III);
- we will remove it and, in case of a positive finding, complete a complete block dissection.
Links[edit | edit source]
Related articles[edit | edit source]
Source[edit | edit source]
- BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 14. 12. 2011]. <http://jirben2.chytrak.cz/materialy/orl_jb.doc>.