Surgical Innovation: Advanced Strategies in the Treatment of Pathologies in the Oropharynx and Parapharyngeal Space

Abstract

Transoral surgery has evolved and its indications for treating diseases of different regions of the head and neck have increased. Pathologies that affect different sectors of the oropharynx and parapharyngeal space can be treated in selected patients through a transoral approach, significantly reducing the morbidity of surgery and the adjuvant treatments. Objectives: To determine the effectiveness of transoral surgery of the oropharynx and parapharyngeal space in patients treated with transoral surgery with microscope (TOMS) for tumors and other pathologies. Methods: Patients treated via transoral approach with the assistance of endoscopes or using a microscope for benign or malignant tumors, as well as other pathologies affecting different regions of the oropharynx (tonsillar fossa, tongue base, and pharyngeal walls) and the parapharyngeal space, between March 2004 and April 2022, were included in the study. To perform the surgeries, cautery, ultrasonic scalpel and CO2 laser were used. Results: Twenty patients with different lesions affecting various regions of the oropharynx and parapharyngeal space were treated using a transoral approach. Ten patients underwent surgery for lesions located at the base of the tongue, two were treated for tumors located in the tonsillar fossa, four patients had lesions located in the posterior and lateral walls of the oropharynx and four patients had lesions located in the parapharyngeal space. Conclusions: Transoral surgery of the oropharynx and parapharyngeal space assisted with endoscopes was highly effective, allowing adequate exposure and complete resection of various benign and malignant tumors, as well as the resolution of other diseases treated using this approach. There was no need to convert the transoral approach to an open procedure. The use of microsurgical technique was infrequent, and we found it to be more suitable for small tumors at the base of the tongue or lesions located in the lower sector of the posterior pharyngeal wall.