Abstract
BackgroundTransoral robotic and laser surgery is rising in popularity due to the increasing incidence of Human Papilloma Virus (HPV) related oropharyngeal cancer. However, adequate exposure of the tongue base remains a major hurdle in many cases. This study introduces a novel surgical technique called the Floor of Mouth Window, which can be used to improve tongue base exposure at the time of transoral surgery.MethodsThis is a preclinical anatomic cadaver study. Seven fresh cadavers were used for this study. Exposure of the tongue base was compared between conventional mouth gags – the Feyh-Kastenbauer and McIvor – and our novel procedure, the Floor of Mouth Window. Exposure was compared subjectively using endoscopic and extracorporeal photographs, as well as objective measurements of inter-incisor distance, and oral cavity volume.ResultsThe exposure achieved by the Floor of Mouth Window technique was superior to the mouth gags. Inter-incisor distance and oral cavity volume measurements were all more favorable with the Floor of Mouth Window. This technique allowed for successful transoral laser tongue base and tonsil resection without the use of gags or scopes.ConclusionThe Floor of Mouth Window is an adjunctive procedure that simply and reliably improved exposure for transoral oropharyngeal surgery in this cadaveric feasibility study. This improved exposure may help increase the adoption of transoral surgery and reduce the number of aborted cases due to anatomic limitations.
Highlights
Transoral robotic and laser surgery is rising in popularity due to the increasing incidence of Human Papilloma Virus (HPV) related oropharyngeal cancer
Transoral surgery is gaining popularity as a treatment option for oropharyngeal cancers [1], which is primarily due to the increasing incidence of small primaries often seen with human papilloma virus (HPV) related disease, as well as the advent of technologies allowing for minimally invasive surgery
After successfully testing feasibility in the first three cadavers, we attempted quantitative comparisons, which consisted of measurements of interincisor distance in four cadavers and volume of the Results In all cadaveric specimens, the exposure offered by the novel Floor of Mouth Window technique was subjectively at least as good if not better than that achieved using the mouth gags
Summary
Transoral robotic and laser surgery is rising in popularity due to the increasing incidence of Human Papilloma Virus (HPV) related oropharyngeal cancer. This study introduces a novel surgical technique called the Floor of Mouth Window, which can be used to improve tongue base exposure at the time of transoral surgery. Transoral surgery is gaining popularity as a treatment option for oropharyngeal cancers [1], which is primarily due to the increasing incidence of small primaries often seen with human papilloma virus (HPV) related disease, as well as the advent of technologies allowing for minimally invasive surgery. Regardless of technique, a good view of the oropharynx with sufficient access for instruments is the most crucial part of the surgery and can present a major challenge in some cases. Studies have shown that as many as 7.8–18% of patients have been deemed unsuitable surgical candidates due to these limitations, and these numbers do not include patients who went on to receive transoral surgery despite suboptimal exposure and significant struggle on the part of the surgeon [4, 5]
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