Treatment of tumors of the oropharynx

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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:
  1. 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.
  2. 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.

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