Transoral retroauricular neck dissection (TREND): A novel combination approach

Abstract

Early-stage oral squamous cell carcinoma is treated preferably by wide local tumour excision along with elective neck dissection. The conventional neck dissection leaves an unaesthetic scar, which remains a major challenge that adversely impacts patient satisfaction, their social interactions, and quality of life (QoL). In recent times, retroauricular assisted endoscopic and robotic neck dissection techniques that avoid unaesthetic neck scars have gained popularity. The pitfalls in attaining universal acceptance of these techniques are the need for specialized instrumentation, training, and increased costs. The need for an endoscope or robotic camera when using the retroauricular approach arises mainly while addressing the level I lymph nodes, due to poor access. A combination of transoral and retroauricular approaches that overcomes these factors is presented here, named the transoral retroauricular neck dissection (TREND). The technique successfully avoids a visible neck scar while providing adequate exposure of level I lymph nodes without the need for specialized instrumentation. This approach has been applied, with adequate lymph node clearance achieved in all patients. This novel combination approach of neck dissection is oncologically safe, easy to replicate, and improves patient aesthetics, functional outcomes, and QoL. We recommend that clinicians practice this simple technique and enhance the practice of remote access neck dissection.