Lateral Pharyngotomy Research Articles

Lateral pharyngotomy for selected invasive squamous cell carcinoma of the lateral oropharynx—part I: How

To revisit the surgical technique of lateral pharyngotomy in patients with selected, isolated, and untreated invasive squamous cell carcinoma of the lateral oropharynx. To describe postoperative management, complications, and functional outcomes. Retrospective review from a French university teaching hospital. Ninety-one patients consecutively underwent lateral pharyngotomy for selected T1–T4 squamous cell carcinoma of the lateral oropharynx. Of the patients, 73.6% and 98.9% experienced an uncomplicated surgical and medical postoperative course, respectively. There were no intraoperative deaths, but a single patient died in the immediate postoperative period from carotid rupture following salivary oropharyngeal fistula. The most common significant complications were severe postoperative swallowing impairment, pneumonia from aspiration, and salivary oropharyngeal fistula noted in 6.5%, 4.3%, and 4.3% of cases, respectively. In univariate analysis, none of the variables under analysis was related to the various significant complications noted and/or to immediate postoperative death. No patient had a permanent tracheotomy, whereas one had a permanent gastrostomy. Of the patients in whom a full course of radiation therapy was delivered postoperatively, 13.6% developed a major complication. From a functional point of view, lateral pharyngotomy is a safe, reliable surgery with few major complications and might be considered a valuable alternative to chemoradiation and/or mandibulotomy for selected tumors of the lateral oropharynx.

Lateral pharyngotomy for selected invasive squamous cell carcinoma of the lateral oropharynx. Part II: When and why

To analyze local failure following lateral pharyngotomy for selected untreated invasive squamous cell carcinoma (SCC) of the lateral oropharynx. Retrospective review from a university teaching hospital. Inception cohort of 91 patients who underwent lateral pharyngotomy for an isolated and previously untreated selected invasive carcinoma of the lateral oropharynx classified as T1 (26), T2 (47), T3 (11), and T4 (7). Induction chemotherapy, neck dissection, and postoperative radiation therapy were used in 91.2%, 94.5%, and 53.5% of patients. The 5-year Kaplan-Meier estimate of local failure was 16.6% for T1, 19% for T2, 38.6% for T3, and 16.7% for T4 lesions (P = .46). In a logistic regression model, only positive margins of resection statistically increased (P = .01) the risk for local failure. In patients with safe margins of resection, the 5-year Kaplan-Meier estimate of local failure was 5.6% for T1 lesions, 10.7% for T2 lesions, 23.8% for T3 lesions, and 20% for T4 lesions (P = .4). Local failure had a significant impact on increased nodal failure (P = .001) and on reduced survival (P < .0001). The lateral pharyngotomy approach should be viewed as a valuable oncologic alternative to both mandibulotomy and chemoradiation in patients with selected SCC of the lateral oropharynx.

側咽頭切開による摘出を行った下咽頭血管腫の1例

下咽頭良性腫瘍は，症状を呈しにくいこともあり，比較的稀な疾患の1つである。今回下咽頭に発生した海綿状血管腫の症例を経験した。症例は79歳，女性，主訴は繰り返す咳嗽であった。下咽頭に声門を覆うような腫瘤を認めた。局所麻酔にて気管切開後，全身麻酔に移行し，喉頭直達鏡を用い，経口法にて摘出を試みたが，腫瘍が大きいこともあり困難であった。そのため，側咽頭切開による摘出に切り替え，大きな出血なく一塊に摘出可能であった。気管挿管の際の腫瘍からの出血の可能性，挿管困難の可能性，術後の喉頭浮腫の可能性を考えると，安全面から気管切開は腫瘍のサイズの大きな症例では必要であると考えられた。下咽頭腫瘍の摘出法として，経口法はワーキングスペースが限られているため，血管腫症例は出血による視野不良となる可能性もあり，安全さ，確実さを考慮すると，外切開による摘出も積極的に行うべきと考えられた。

Pharyngeal fibromatosis presenting as adenoid hypertrophy: A case report and review of literature

A 10-year-old girl presented with a noisy breathing noticed from birth and failure to thrive. Examination revealed a huge lobulated firm mass in the oropharynx (toward the left side). Plain radiography of the neck showed a huge circumscribed pharyngeal mass extending from the base of the tongue to the level of the fourth cervical vertebrae. The mass measuring 6 cm Χ 5 cm was excised through a left lateral pharyngotomy. Histological examination showed sections of highly cellular interlacing bundles of fibroblast with moderate hyalinization extending to the surrounding fibro-fatty tissue. The cells have spindle nuclei with tapering ends. Occasional mitosis and in some areas myxoid degeneration were seen. A diagnosis of pharyngeal fibroma was made. Patient had an uneventful post-operative recovery with complete resolution of symptoms for the past 6 years. This rare benign tumor has not previously been reported at this site and may thus give rise to difficulty in diagnosis or to a misdiagnosis.

Surgical Management of Recurrent Laryngeal Glomus

ABSTRACT A 51-year-old male presented to the ENT outpatient department with complaints of pain, irritation and foreign body sensation in the throat for 3 months. There was history of being diagnosed to have laryngeal paraganglioma for which the patient had undergone microlaryngeal surgical excision twice during the preceding 9 years. Clinical examination revealed a reddish proliferative mass of about 2 cm involving the laryngeal surface of the epiglottis and extending to the right aryepiglottic fold. Vocal cords were normal in structure and function. With the previous history of endolaryngeal excision of the tumor and its recurrence, the patient underwent laryngofissure approach with median thyrotomy and left lateral pharyngotomy. The tumor was excised in toto and histopathologically confirmed as paraganglioma. Postoperative period was uneventful. Patient is on continued follow-up with no recurrence till date. How to cite this article Samuel J, Mohanty S, Maraignanam G. Surgical Management of Recurrent Laryngeal Glomus. Int J Phonosurg Laryngol 2013;3(1):12-14.

Laryngeal Paraganglioma: A Rare Clinical Entity Managed by Supraselective Embolization and Lateral Pharygotomy

Laryngeal paragangliomas are benign slow growing tumors with symptoms resembling squamous cell carcinoma. Hoarseness or dysphasia are the commonest presenting symptoms and usually it presents as an submucosal mass on laryngoscopy. Ninety percentage of these tumors occur in the supraglottic larynx and the rest in the glottis and the subglottic region. Functional activity is seen in a few (2.9%), none are associated with paraneoplastic syndromes. A 35-year-old male presented to us with hoarseness of voice since 4months duration. Contrast arteriography demonstrated that the left superior thyroid artery supplied >80% of the blood supply to the laryngeal mass. Supraselective embolization was done from the right femorals under local anaesthesia and sedation which was uneventfull. The tumor was excised from lateral pharyngotomy approach with an partial laryngectomy procedure. Microscopy and immune-histochemistry confirmed it to be paraganglioma. Complete surgical resection or partial laryngectomy with meticulous dissection of surrounding tissues and preservation of neurovascular structures gives an excellent prognosis as far as oncological clearance is concerned. Malignant paragangliomas of the larynx are rare and an major meta-analysis is necessary to provide a true biological behaviour of this tumor.

Jan Mikulicz-Radecki (1850–1905): a fundamental contributor to world surgery; surgeon of the head, neck, and esophagus

We present some of many valuable and unique achievements of Jan Mikulicz-Radecki with special regard to his contribution to laryngology. He constructed esophagogastroscope, and was one of the first to perform endoscopy of esophagus and ventricle. He published several papers describing new approaches to maxillary sinus through inferior meatus, surgical management of tonsillar cancer via lateral pharyngotomy, correction of post-traumatic nasal deformations, and the use of iodophorm in healing wounds. Among Mikulicz’s many celebrated scientific achievements, the most important remains the development of asepsis and creation of a surgical school, which was a modernized continuation of Langenbeck–Billroth achievements.

Can the transoral approach secure a cancer-free deep margin in tonsil cancer?

To verify whether the submuscular plane of the constrictor muscle, which is the resection margin in a transoral approach, is sufficient for securing a cancer-free deep margin in tonsil cancer patients. Retrospective analysis of medical records and pathology specimens was done in sixty-two patients who were diagnosed with tonsil cancer and underwent surgery via a combined transoral-transcervical (transoral and transcervical lateral pharyngotomy) approach. The status of constrictor muscular invasion in tonsil cancer patients according to the TN stage and its predictors was investigated. Invasion or penetration of the constrictor muscle was found in three (27.3%), 30 (76.9%), and 12 (100%) stage T1, T2, and T3-4 patients, respectively. In the univariate analysis, invasion or penetration of the constrictor muscle was significantly correlated with gender (p=0.004), stage >T2 (tumor ≥2 cm; p=0.001), and N(+) (p=0.004). The multivariate analysis showed that stage >T2 [tumor ≥2 cm; odds ratio (OR), 18.226; 95% confidence interval (CI), 2.976-111.608; p=0.002] and N(+) (OR, 7.560; 95% CI, 1.478-38.671; p=0.015) were significantly correlated with an increased risk of muscle invasion or penetration. The transoral approach is seems to be insufficient for securing a cancer-free deep margin in tonsil cancer beyond stage T2 or N1. The tumor beyond this stage should be treated more aggressively using multiple treatment modalities including radical surgery, chemotherapy, and radiotherapy.

Supraglottic Laryngeal Paraganglioma: A Rare Clinical Entity managed by Lateral Pharyngotomy Approach

ABSTRACT Background/objectives Laryngeal paragangliomas are benign slow growing tumors with symptoms resembling squamous cell carcinoma. Hoarseness or dysphasia is the commonest presenting symptom and usually it presents as a submucosal mass on laryngoscopy. A total of 90% of these tumors occur in the supraglottic larynx and the rest in the glottis and the subglottic region. Functional activity is seen in a few (2.9%), none are associated with paraneoplastic syndromes. Setting Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru. Case report A 35-year-old male presented to us with hoarseness of voice since 4 months duration. Contrast arteriography demonstrated that the left superior thyroid artery supplied greater than 80% of the blood supply to the laryngeal mass. Superselective embolization was done from the right femoral under local anesthesia and sedation which was uneventful. Intervention The tumor was excised from lateral pharyngotomy approach with an elective tracheostomy. Microscopy suggested it to be paraganglioma and immunohistochemistry confirmed it. Conclusion Complete surgical resection or partial laryngectomy with meticulous dissection of surrounding tissues and preservation of neurovascular structures give an excellent prognosis as far as oncological clearance is concerned. Malignant paragangliomas of the larynx are rare and a major meta-analysis is necessary to provide a true biological behavior of this tumor. How to cite this article Naik SM. Supraglottic Laryngeal Paraganglioma: A Rare Clinical Entity managed by Lateral Pharyngotomy Approach. Int J Phonosurg Laryngol 2012;2(2): 69-73.

A Case of Lingual Thyroid Resected by a Lateral Pharyngotomy Approach

A Case of Lingual Thyroid Resected by a Lateral Pharyngotomy Approach

Classification System for Lateral Pharyngotomy

Objective: 1) Propose a classification system of lateral pharyngotomy (LP) used in exposing various sites of the oropharynx, supraglottis, and hypopharynx. 2) Describe the structures visible with each category of lateral pharyngotomy. Method: An anatomic study on 5 fresh-frozen human cadavers was carried out at the Medical Education and Research Institute. After exposure of the anterior compartment of the neck and laryngeal framework, progressively more extensive pharyngotomy was performed. The pharyngeal structures exposed with each extension were recorded by video and still photography. Results: Entry into the pharynx between the hypoglossal nerve cephalically and the superior laryngeal nerve caudally (Type I LP) provided exposure of the epiglottis and ipsilateral tongue. Exposure toward the pyriform apex was facilitated by dividing the superior laryngeal artery (Type II LP). This provided exposure to the postcricoid area, arytenoids, and cervical esophageal inlet. The digastric and stylohyoid muscles were transected (Type III LP) to provide exposure of the entire base of tongue, uvula, and soft palate. Division of the hyoglossus and mylohyoid muscles was classified as Type IV LP, adding visualization of the vallecula and contralateral tonsil. Conclusion: An appropriate class of pharyngotomy may be chosen depending on the structures requiring exposure. This cadaver-based anatomic study delineated the anatomic structures to be divided to facilitate exposure of pharyngeal subsets. A classification system is proposed that defines the steps in gaining access to the pharynx.

Angiolipoma Larynx: A Case Report

We report an extremely rare case of angiolipoma larynx Case report and a review of the world literature concerning angiolipoma are presented. A case of tumour of the larynx in a 72-year-old male who underwent excision by a lateral pharyngotomy approach. Histopathological diagnosis was angiolipoma. 19 cases of angiolipoma have been reported from head and neck region, none from the larynx. To our knowledge this is the first report in the world literature of angiolipoma larynx.

Larynx-Preserving Partial Pharyngectomy via Lateral Pharyngotomy for the Treatment of Small (T1~2) Hypopharyngeal Squamous Cell Carcinoma

ObjectivesTo evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC).MethodsWe performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy.ResultsThe 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function.ConclusionLPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.

Benign Corrosive Stricture Excision by Lateral Pharyngotomy

ABSTRACT Benign corrosive lesion of aerodigestive tract is difficult to treat. We report a case of a 3-year-old male child who accidentally ingested acid and presented to the emergency a few hours later with difficulty in breathing and dysphagia. He was admitted and underwent a tracheotomy. A feeding jejunostomy was also done. The patient was then planned for an endoscopic examination followed by a lateral pharyngotomy. A few weeks later, a bougie dilatation of the esophageal stricture was done and the dysphagia was relieved.

Surgical Approach for Oropharyngeal Cancer

Received August 17, 2011 Revised October 18, 2011 Accepted October 19, 2011 Address for correspondence Kyung Tae, MD Department of OtorhinolaryngologyHead and Neck Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea Tel +82-2-2290-8585 Fax +82-2-2293-3335 E-mail kytae@hanyang.ac.kr Background and ObjectivesZZIn order to eradicate the disease and preserve function of oropharynx and facial contour, appropriate surgical approach should be chosen for surgical treatment of oropharyngeal cancer. This study was performed to evaluate the usefulness and effectiveness of various surgical approaches in the surgical treatment of oropharyngeal cancer. Subjects and MethodZZWe analyzed 65 patients with oropharyngeal cancer who underwent surgery as a primary treatment from Jan. 1994 to Jun. 2009, retrospectively. Primary tumor site, TNM stage, surgical approach, management of neck, reconstruction method, complication, recurrence rate were analyzed to assess advantages and disadvantages of various surgical approaches. ResultsZZThe surgical approaches applied were transoral approach in 25, mandibulotomy in 23, lower cheek flap in 4, trans-pharyngeal in 9, and mandibular lingual releasing approach in 4. Most of T1 lesion was resected by transoral approach (65.0%). For advanced T3 and T4, mandibulotomy was mainly used. Lateral pharyngotomy and mandibular lingual release approach were used for the surgery of moderate size of oropharyngeal cancer. The locoregional recurrence rate did not differ according to different surgical approaches with regard to T and N stages. ConclusionZZTransoral approach is very useful for the most of small oropharyngeal cancer. Mandibulotomy provides most wide surgical view for advanced T3, T4 oropharyngeal cancer. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:853-8

Laryngeal Schwannoma Excision by Lateral Pharyngotomy

ABSTRACT Neurogenic tumors of the larynx are extremely rare. Here, we are reporting a case of laryngeal schwannoma presenting as supraglottic submucosal lesion with hoarseness and stridor, which was excised by lateral pharyngotomy approach. This presentation is to further discuss the histology of neurogenic tumors, modes of presentation, differential diagnosis and treatment modalities.

Transoral Robotic Reconstruction of Oropharyngeal Defects: A Case Series

Large resections of oropharyngeal tumors in the absence of a mandibulotomy create a reconstructive challenge, because flaps are often necessary, and inset requires contouring and suturing in a confined space with limited line of sight. Transoral robotically assisted reconstruction is the logical solution. The DaVinci Surgical System was used in five cases of oropharyngeal reconstruction. All oropharyngeal tumors were resected without a mandibulotomy, using either a transoral robotic approach or a lateral pharyngotomy. Robotic reconstruction was performed using a radial forearm, an anterolateral thigh flap, a facial artery myomucosal flap, and primary closure. The robot was also used to perform an arterial anastomosis. All cases were performed with an intact mandible. This resulted in complex oropharyngeal defects with limited access. The robot was used to inset free flaps or local flaps, or to close primarily by improving access and precision in the oropharynx. The robot was used to perform a microvascular anastomosis between two, 2-mm arteries without hand-sewn revision. There were no surgical complications, flap failures, take-backs, or fistulas. All patients have been decannulated and are tolerating an oral diet without tube feeding. Minimally invasive resections provide locoregional control without the morbidity of mandibulotomy or high-dose chemoradiation. Transoral robotic reconstruction allows access and precision within the oropharynx. It is safe and effective, and may expand minimally invasive resections where reconstruction is not possible through traditional approaches.

Surgical treatment of tongue base carcinoma using upper lateral pharyngotom

The patients with tongue base carcinoma are usually diagnosed in an advanced stage of the disease. The authors present a retrospective analysis of four patients treated in the period 2006-2008 using the method of upper lateral pharyngotomy in order to remove the tumor. On the basis of the preoperative evaluation two of the patients had ipsilateral neck dissection. The authors report the survival rate giving the account of the combined treatment and the necessity of extra procedures. The article describes the operative techniques and the important moments of making a decision. A review of the literature concerning this matter has been made.

Kimura's disease of the epiglottis: Resection by a lateral pharyngotomy approach

Kimura's disease of the epiglottis: Resection by a lateral pharyngotomy approach

P2.37. The utility of lateral pharyngotomy and pull through approach in oral cavity and oropharyngeal cancer

P2.37. The utility of lateral pharyngotomy and pull through approach in oral cavity and oropharyngeal cancer