Transoral Route Research Articles

Retropharygneal node dissection

Metastasis to the retropharyngeal lymph nodes is not common for malignancies of the upper aerodigestive tract, salivary glands or thyroid. However, retropharyngeal metastasis is not a rare occurrence either and lymph node dissection may be required for therapeutic purposes. Prompt identification and management is paramount for disease control. Evidence of nodal involvement is the main indication for surgical dissection if radiotherapy is not available or effective. Significant extranodal extension with carotid or prevertebral involvement are considered contraindications to dissection. Surgical approach selection is vital as access can be limited. Both transcervical and transoral routes are available for appropriately experienced surgeons. Each approach has its advantages and disadvantages in set up, safety, and postoperative complications. These factors, along with need for concurrent tumor treatment should be considered when dissecting these lymph nodes.

Feasibility of completion thyroidectomy via transoral endoscopic vestibular approach.

Transoral endoscopic thyroidectomy is widely utilized for treating benign conditions and low-risk thyroid cancers, yet its use for completion thyroidectomy, especially when performed more than 2 weeks after an initial lobectomy, is less understood. In this retrospective study, we assessed patients who underwent endoscopic completion thyroidectomy via the transoral route, examining operative data and complications from both the initial lobectomy and the subsequent completion thyroidectomy, along with the pathological and oncologic outcomes of the latter surgery. Among the ten patients diagnosed with papillary carcinoma following an initial lobectomy who underwent a completion thyroidectomy via the same transoral approach, the median interval between surgeries was 5.4 months, with 80% of cases exceeding 3 months. All procedures were completed endoscopically without necessitating an open conversion. In 40% of these patients, additional microcarcinomas were identified in the contralateral thyroid lobe. Although the median operative time for completion thyroidectomy was longer (249min) compared to the initial lobectomy (220min), and postoperative pain scores on days 1 and 2 were slightly higher, and these differences were not statistically significant. Blood loss, drainage amounts, and hospital stay lengths were similar between both surgeries. The only major complication was transient hypoparathyroidism, occurring in 20% of the completion group, with 80% of patients achieving suppressed thyroglobulin levels of < 0.2ng/mL postoperatively. Our findings demonstrate the practicality of using the transoral endoscopic vestibular approach for completion thyroidectomy, even when conducted more than 3 months after the initial lobectomy.

Precision-Targeted Injection Laryngoplasty and Longitudinal Biomaterial Effects Evaluation Using High-resolution Ultrasonography in a Rat Model.

Current laryngeal injection models rely on the transoral route and are suboptimal due to limited view, narrowed working space, and the need to sacrifice animals for investigation of the injectables. In the present study, a novel surgical model for laryngeal intervention therapy utilizing an ultra-high frequency ultrasound imaging system was proposed. Based on this system, we developed a systemic evaluation approach, from guidance of the injection process, documentation of the injection site of the material, to in vivo longitudinal follow-up on the augmentation and medialization effect by analyzing the ultrasonography data. In vivo animal study. Academic institution. Injection laryngoplasty with hyaluronic acid under ultrasonography guidance was performed on Sprague-Dawley rats one week after induced unilateral vocal paralysis. Ultrasonography was performed at preinjection, immediately postinjection, on Day 2, Day 7 and then weekly for 4 weeks to obtain measurements, including the glottic area, angle between bilateral folds, and vocal fold width ratio. Laryngoscopic and histologic studies were also performed. Unilateral injections to the paralyzed fold were successfully performed as demonstrated by ultrasonographic, laryngoscopic, and histologic studies. The width ratio was significantly increased after injection for 4 weeks, while the glottic airway area was unchanged. Here, a novel surgical model for laryngeal injection utilizing ultrasonography in rats was established. In addition to providing visual guidance for precise localization of the injection, robust documentation of the treatment effect was also demonstrated. This methodology could be beneficial for screening therapeutic agents for treatment of glottic insufficiency.

Navigated Anterior Full-Endoscopic Transcervical Approach Odontoidectomy for Traumatic Posterior Atlantoaxial Dislocation Without Odontoid Fracture.

Complete posterior atlantoaxial dislocation (PAAD) with an unfractured odontoid process is a rare condition where a dislocated but intact odontoid process is positioned ventrally to the anterior arch of C1. This lesion is related to transverse and alar ligament rupture secondary to hyperextension and rotatory traumatic injury and is often associated with neurological deficit. The treatment strategy remains controversial, and in many cases, odontoidectomy is required. Traditional approaches for odontoidectomy (transnasal and transoral) are technically demanding and are related to several complications. This article describes a 360° reduction and stabilization technique through a navigated anterior full-endoscopic transcervical approach (nAFETA) as a novel technique for odontoidectomy and C1-C2 anterior transarticular fixation supplemented with posterior fusion. A 21-year-old man presented to the emergency room by ambulance after a motorcycle accident. On evaluation, incomplete ASIA B spinal cord injury was documented. Imaging revealed a complete PAAD. We performed a two-staged procedure, a nAFETA odontoidectomy plus C1-C2 anterior transarticular fixation followed by posterior C1-C2 wired fusion. At a 2-year follow-up, the patient had a 10-point Oswestry Disability Index score and neurological improvement to ASIA E. PAAD can be successfully treated through minimally invasive nAFETA. Noteworthy, the risks of the transoral and endonasal routes were avoided through this approach. In addition, nAFETA allows anterior transarticular fixation during the same procedure providing spinal stability. Further studies are required to expand the use of nAFETA in this field.

Anterior retropharyngeal approach (ARPA) for high cervical spine.

One of the major challenges in operating on the spine lies in taking an anterior approach for the high cervical spine. In patients with a short neck, Klippel-Fiel syndrome or when the C3 vertebra is high in relation to the hyoid bone, it will be difficult to access the C3 body. The transoral route is a highly contaminated zone, and therefore, no instrumentation or grafts can be placed through it. The anterior retropharyngeal approach (ARPA) for the high cervical spine. The anterior retropharyngeal approach is an excellent approach for the high cervical spine where instrumentation is needed. This route provides wide exposure of the C1-C3 region, avoiding the contaminated of the oral cavity.

Teratoma presenting as a nasal polypoidal mass in a newborn: an endoscopic resection

Introduction: Extragonadal teratomas are more common in the sacrococcygeal region. Although teratomas arising from the head and neck region are rare, they can give rise upper airway obstruction in the newborn, requiring early excision. A ‘term’ new born delivered with a polypoidal mass protruding through the right nostril, developed respiratory distress due to upper airway obstruction and required intubation. CT and MRI scan of the head showed an irregular shaped mass occupying the right nasal cavity, nasopharynx and protruding into the oral cavity with the possibly of being a teratoma. The tumour was resected endoscopically via transnasal and transoral routes. Histopathology confirmed it as mature teratoma.Conclusion: Although most teratoma are benign and asymptomatic, teratomas arising in the head and neck can give rise to upper airway obstruction and respiratory distress in new born and requires intubation to secure airway and early resection.

Endoscopic-assisted en-bloc pterygomaxillectomy: Identifying an efficient and safe location for the pterygoid osteotomy.

For aggressive maxillary sinus and pterygopalatine fossa (PPF) tumors, an en-bloc pterygomaxillectomy may be indicated. Five head specimens were used to study the feasibility of an en-bloc pterygomaxillectomy. Eighty-five non-pathological CT scans were used to compare the superior edge of the inferior turbinate (IT) and the middle turbinate tail (MT) as landmarks for the pterygoid osteotomy. Through a combined sublabial-subperiosteal incision and transoral route, a mid-sagittal osteotomy through the hard palate and an axial osteotomy below the infraorbital foramen were performed. For the endoscopic pterygoid osteotomy, an infra-vidian transpterygoid approach was performed, subsequently removing the pterygomaxillectomy en-bloc. As landmarks, the osteotomies at the level of the MT tail and IT resected the pterygoid plates completely, but the IT osteotomy was further away from the vidian canal (7.5 vs. 6 mm). The endoscopic-assisted en-bloc pterygomaxillectomy is feasible. The IT landmark is safe and ensures complete resection of the pterygoid plates.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA). Recommendations of the AFCE (Francophone Association of Endocrine Surgery) with the SFE (French Society of Endocrinology) and the SFMN (French Society of Nuclear Medicine)

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) can be proposed for selected patients with a thyroid volume < 45 mL and/or a nodule < 4 cm (for Bethesda category II, III or IV lesions), or < 2 cm (for Bethesda category V or VI lesions), with no suspicion of lateral nodal involvement or mediastinal extension who wish to avoid a cervical scar. Such patients should have satisfactory dental status, have been educated on the specific risks of the transoral route and the need for perioperative oral care, and also fully informed regarding the lack of proof of TOETVA effectiveness in terms of quality of life and patient satisfaction. The patient should be made aware of the possibility of postoperative pain in the neck cervical and chin, which may persist for several days to a few weeks after the intervention. Transoral endoscopic thyroidectomy should be performed in centers with expertise in thyroid surgery.

Transoral thyroid surgery vestibular approach.

Transoral thyroid surgery vestibular approach (TOETVA) is a novel and feasible surgical technique that allows for cervical surgery without visible incisions. TOETVA represents a new frontier in endocrine surgery since aesthetic results play a more and more decisive role in elective surgery. However, acceptance is different around the world with widespread prevalence in Asian countries and some high-volume centres in the US. While inclusion criteria for TOETVA are limited regarding size and volume a combination with other extracervical techniques like the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) approach or transaxillary access is an option. TOETVA is carried out through a three-port technique placed at the oral vestibule. Originally one 10-mm port for a 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments are used. Alternatively, one 5-mm and one or two 3mm ports can be used. CO2 insufflation pressure is set at 6mmHg. An additional device to optimize gas outflow for optimum view might be helpful. An anterior cervical subplatysmal space is created by hydrodissection from the oral vestibule to the sternal notch, laterally to the sternocleidomastoid muscle. Conventional endoscopic instruments are used. Combination of TOETVA with a modified retroauricular access includes insertion of a 10-12mm trocar placed subcutaneously via a skin incision on the scalp, behind the ear by blunt dissection. Since Anuwong published the first case series of 60 patients who underwent scarless thyroidectomy via the lower vestibule of the mouth with excellent results in 2016almost 1,000 cases are reported in literature to date with comparable results especially regarding traditional complications. In contrast to other extracervical approaches, areolar or axillary for example, the transoral access route is short and the dissection planes are rather like transcervical surgery. Surgical indications and contraindications have been modified since its first description and are partly institution specific to date. To amend indications combination with other extracervical techniques is an option. In addition, patients must carefully be selected for and surgeons` candidacy is of utmost importance in transoral surgery. Transoral surgery will likely continue to gain attraction as surgeons become more experienced with the technique. With increased operative use and surgeon experience the gap in conventional outcomes between transoral surgery and the transcervical approach will narrow, with both operative time and the incidence of specific complications diminishing. Experience in thyroid and endoscopic surgery is required to achieve excellent results with low complication rates. However, the new transoral technique is related to novel complications that must be evaluated.

Endoscopic Endonasal Approach to a Giant Dentigerous Cyst

Dentigerous cysts constitute 20% of all odontogenic cysts and are often located in the mandible and maxilla. They are often seen at young ages and in men. Patients are usually asymptomatic, and the diagnosis is established by dental radiographs in routine scans. Surgery is recommended for dentigerous cysts because ameloblastoma, intraosseous mucoepidermoid carcinoma, or intraosseous squamous cell carcinoma may develop from them. Generally the transoral route is preferred over the endoscopic route for dentigerous cysts located in the maxilla. In addition to the question of the transnasal versus oral approach to dentigerous cysts, another controversy is the removal or marsupialization of the entire cyst. In our 10-year-old male patient, a cyst that completely filled the right maxillary sinus and eroded the lateral and anterior wall of the maxillary sinus was treated with transnasal endoscopic surgery. The cyst wall and 3 permanent teeth were removed endoscopically. No post-operative complications were observed. The patient’s age and the location and size of the cyst play an important role in the choice of treatment. Furthermore, the most accurate way to choose the appropriate treatment is to make the treatment decision with a multidisciplinary approach.

Endoscopy-assisted transoral approach for parapharyngeal space tumors: Our experience and a systematic review of the literature.

Several approaches have been described for the excision of parapharyngeal space tumors (PPSTs). Advances in endoscopy gave a further stimulus to the use of the transoral route. We present our experience with the endoscopy-assisted transoral approach (EATA) in this regard and a review of the most recent literature about EATA for PPSTs excision. We retrospectively analyzed our experience and systematically reviewed the literature about the outcomes of this technique. Seven PPSTs were completely excised, with three of them requiring a combined transcervical approach. Only one case of postoperative wound dehiscence was registered, and the mean length of stay was 3.9 days. Final histopathological examination confirmed the results obtained with preoperative fine-needle aspiration biopsy in all cases and no recurrences were apparent after a mean follow-up of 28.1 months. Magnetic resonance imaging, the modified Mallampati score and the 8 Ts criteria are useful instruments for the choice of the most appropriate surgical approach. In light of our experience and following other published series in the literature, we believe that EATA may represent a safe and effective approach for the treatment of the majority of PPSTs.

Review of transoral odontoidectomy. Where do we stand? Technical note and a single-center experience

BackgroundTransoral odontoidectomy followed by occipitocervical fixation is an accepted technique for the treatment of ventral compression at the craniocervical junction (CVJ). It is thought that surgical experience has stagnated owing to both the development of endonasal approaches, and improvement in rheumatoid pharmaceutical therapies. Accurate knowledge on whether the declining experience affects rates of intra-operative and peri-operative complications is essential. Herein, we present an illustrated technical note and case series based on our 10-year surgical experience. MethodsTechnical pearls for the transoral ondontoidectomy approach are discussed and illustrated. A retrospective analysis of patients aged 18 years or older who underwent the procedure over the last 10 years was conducted. Both intra and post-operative complications were recorded and compared to historical controls. ResultsTen patients were identified with an average of 60 years of age and follow-up time of 15 months. Indications for surgery included rheumatoid (10%), degenerative (30%) and pseudogout cervical pannus (10%), basilar invagination (30%), and malignancy (20%). Average length of stay was 19.4 days. Two patients suffered from intra-operative CSF leaks while 8 patients suffered from post-operative medical complications including the need for tracheostomy for 4 individuals. Rate of improved neurological outcomes was 60% while 20% of patients were stable at last clinic follow-up. ConclusionIn this study, we describe our technique to obtain exposure and perform decompression of CVJ ventral pathologies via the transoral route. The intra and post-operative complications we report represent the common pitfalls. Highly specialized and comprehensive patient care remains essential as post-operative complication rates remain high.

Anterior Approach to the Cervical Spine: Elegance Lies in Its Simplicity.

Introduction:Since the landmark publication by Smith and Robinson, approaches to the cervical spine anteriorly have undergone many modifications and even additions. Nevertheless, at its core, the anterior approach remains an elegant and efficient approach to deal with majority of cervical spine pathologies including the degenerative cervical spine.Methodology:For this review, we searched for all major cases series and randomized control trials of anterior cervical approaches using the PubMed databases. Articles having the details of clinical variables and outcomes were tabulated and analyzed.Results:A total of 9 case series for transoral, 7 case series for transmanubrial, 19 case series for anterior cervical discectomy and fusion (ACDF), 6 studies for ACDF versus posterior cervical foraminotomy, 37 case series for ACDF versus arthroplasty, and 7 studies for ACDF versus anterior cervical corpectomy and fusion have been included. The majority of the case series suggested that the anterior cervical procedures have good clinical outcomes. The upper cervical spine approached by the transoral route had good outcomes in ventral compressive pathologies, with morbidity of cerebrospinal fluid leak in 7% of patients. The midcervical spine approached by ACDF had better clinical outcomes equivalent to the majority of modifications even in multiple-level pathologies. The transsternal approach had provided greater access and stability to the cervicothoracic junction with minimal morbidity.Conclusion:The anterior cervical approach can address the majority of cervical pathologies. They provide adequate corridor from craniovertebral junction to T4 with minimal morbidity, thus providing a good clinical outcome.

P.203 Clinical outcomes of endoscopic endonasal odontoidectomy: A single center experience

Background: Odontoidectomy for basilar invagination and craniovertebral junction pathology has traditionally been performed using a transoral route. However, the endoscopic endonasal approach to the anterior craniovertebral junction may offer safer and more effective access when compared to transoral approaches. Methods: This study is a retrospective chart review of all adult patients who underwent an endoscopic endonasal odontoidectomy at a single tertiary care center between January 2011 and May 2019. Results: Seventeen patients were included in the study. The median admission age was 67 years (range: 33-84 years) and 65% of the patients were female. One patient (1/17, 6%) had vertebral artery injury which was coiled with no neurological deficits, and 4 patients (4/17, 24%) had intraoperative CSF leaks with no postoperative leak. Fourteen patients (14/17, 82%) were extubated by POD 1. Three patients (3/17, 18%) developed postoperative sinus infections and required antibiotics. Eight patients (8/17, 47%) developed transient postoperative dysphagia. One patient (1/17, 6%) had postoperative epistaxis and one patient (1/17, 6%) had postoperative lower cranial nerve symptoms. The median length of hospital stay was 13 days (range: 2-44 days). Conclusions: Endoscopic endonasal odontoidectomy is a feasible and well-tolerated procedure for anterior decompression of craniovertebral junction, associated with satisfactory patient outcomes and low morbidity.

Endoscopic transnasal/transoral odontoid resection in children: results of a combined neurosurgical and otolaryngological protocolized, institutional approach.

Odontogenic ventral brainstem compression can be a source of significant morbidity in patients with craniocervical disease. The most common methods for odontoidectomy are the transoral and endoscopic endonasal routes. In this study, the authors investigated the use of an institutional protocol for endoscopic transnasal/transoral odontoidectomy in the pediatric population. From 2007 to 2017, a multidisciplinary institutional protocol was developed and refined for the evaluation and treatment of pediatric patients requiring odontoidectomy. Preoperative assessment included airway evaluation, a sleep study (if indicated), discussion of possible tonsillectomy/adenoidectomy, and thorough imaging review by the neurosurgery and otolaryngology teams. Further preoperative anesthesia consultation was obtained for difficult airways. Intraoperatively, adenoidectomy was performed at the discretion of otolaryngology. The odontoidectomy was performed as a combined procedure. Primary posterior pharyngeal closure was performed by the otolaryngologist. The postoperative protocol called for immediate extubation, advancement to a soft diet at 24 hours, and no postoperative antibiotics. Outcome variables included time to extubation, operative time, estimated blood loss, hospital length of stay, and postoperative complications. A total of 13 patients underwent combined endoscopic transoral/transnasal odontoid resection with at least 3 years of follow-up. All patients had stable to improved neurological function in the postoperative setting. All patients were extubated immediately after the procedure. The average operative length was 201 ± 46 minutes, and the average estimated blood loss was 44.6 ± 40.0 ml. Nine of 13 patients underwent simultaneous tonsillectomy and adenoidectomy. The average hospital length of stay was 6.6 ± 5 days. The first patient in the series required revision surgery for removal of a small residual odontoid. One patient experienced pharyngeal flap dehiscence requiring revision. A protocolized, institutional approach for endoscopic transoral/transnasal odontoidectomy is described. The use of a combined, multidisciplinary approach leads to streamlined patient management and favorable outcomes in this complex patient population.

Laparoscopic assisted trans-gastric endoscopic retrograde cholangiopancreatography (LA-ERCP) for postoperative bile leakage: A case report

Laparoscopic assisted trans-gastric endoscopic retrograde cholangiopancreatography (LA-ERCP) is a safe and effective technique for cholelithiasis. We report a successful treatment case through LA-ERCP in patient with bile leakage after laparoscopic common bile duct (CBD) exploration because of the patient's limited degree of mouth opening due to trismus and limb stiffness. Here we present a case of a 51-year-old male patient with trismus, limb stiffness after suffering from poliomyelitis. The patient showed acute calculous cholecystitis and acute cholangitis with distal CBD stones. He was unable to receive trans-oral ERCP or percutaneous trans-hepatic biliary drainage (PTBD) because of the limited degree of mouth opening due to trismus and stiffness in his both arm across his chest. So we performed laparoscopic cholecystectomy and removed distal CBD stones through CBD exploration. On the fourth day after the operation, bile leakage was observed. Because he was unable to receive trans-oral ERCP or PTBD, we decided to perform LA-ERCP. We performed LA-ERCP and successfully inserted endoscopic retrograde bile duct drainage (ERBD) into the common bile duct. During the procedure, the endoscope was introduced through a gastrostomy, obviating the need for an intragastric trocar. The patient underwent ERBD. The patient was discharged on 11 postoperative day without any complications. For the patients in whom trans-oral and trans-hepatic route are unavailable, LA-ERCP represents an effective approach for the management of biliary complications after laparoscopic cholecystectomy and offers a novel solution.

Combined Percutaneous Kyphoplasty/Pediculoplasty by Posterolateral Transpedicular Approach for Painful Cervical Spine Metastases: A Single-Center Prospective Study.

PurposeIn patients requiring percutaneous kyphoplasty (PKP) for painful cervical spine metastases (PCSMs), the surgical approach is of utmost importance. Anterolateral and transoral routes are generally used at present, whereas PKP as well as percutaneous pediculoplasty (PPP) via posterolateral transpedicular approach (PTPA) has yet to be pursued in the treatment of PCSMs. The study was designed to evaluate safety and efficacy of PKP procedures combined with PPP via PTPA as treatment of PCSMs.Patients and MethodsThe patients with PCSMs were enrolled and housed in a database. The pain intensity of enrolled patients was gauged by Visual Analog Scale (VAS), ranging from 0 (none) to 10 (extreme). After preprocedural imaging assessment, combined PKP/PPP via PTPA was performed under the guidance of CT and fluoroscopic monitoring. Postprocedural VAS scores, complications, cement dosage, and hospitalization were recorded in the database for analysis. All cases were followed up for 6 months.ResultsAdult enrollees (7 women, 4 men) with PCSMs successfully underwent PKP/PPP via PTPA between February 2019 and January 2020, injected with 3.7±0.7 mL (range, 2.5–4.8 mL) of cement on average. Other than a single instance of asymptomatic cement leakage into paravertebral soft tissues, no complications ensued. Significant analgesic effects observed 24 hours after procedures were sustained for up to 6 months in follow-up surveys. Postprocedural hospitalizations were as brief as 2.2±0.8 days.ConclusionCombined PKP/PPP via PTPA is safe and effective as treatment of PCSMs, enabling quick pain relief and patient recovery.

Endoscopically assisted transoral resection of a Bailey type IV second branchial cleft cyst

Rationale:The diagnosis of type IV branchial cleft cyst (BCC) according to the Bailey classification is very challenging due to lack of specific clinical manifestations in the early stage of the disease. Here, we present the transoral surgical route of endoscopic resection of second BCC in the parapharyngeal space (PPS) with good outcomes.Patient concerns:A 21-year-old man with a 1-year history of snoring complained about sore throat for 1 month and a fever that lasted for 3 days.Diagnoses:On admission, physical examination revealed a temperature of 39°C, pain when swallowing accompanied with a lump sensation in the throat, and inability to open mouth more than 3 cm. Blood testing revealed 19.29 × 109 white blood cells (WBCs)/L and 14.94 × 109 neutrophils/L. A cervical computed tomography (CT) examination revealed a mass with liquid density of 6.2 × 4.0 × 7.7 cm3 in the left parapharyngeal space (PPS) and pharyngeal cavity stenosis. Postoperative pathology showed the existence of lymphoepithelial cysts (left PPS), which was in accordance with the diagnosis of BCC.Interventions:The patient was administered 1.5 g ceftazidime every 12 hours, anti-inflammatory drugs, and incision drainage was performed subsequently. Then, endoscopy-assisted resection of the left PPS was performed via the transoral route. We used low-temperature plasma and an 8-Fr Foley catheter with a water capsule during the surgery.Outcomes:After resection of the mass, the patient's blood results returned to within the normal range and his symptoms improved. Five days postoperatively, the incision made in the palatine arch of the pharynx opened up by 1 cm, and eventually the wound and laceration healed. Normal oral eating was restored, and no complications were observed.Lessons:Magnetic resonance imaging (MRI), and color Doppler ultrasound can be useful to diagnose BCC in PPS, which rarely occurs in the clinical setting. Extended endoscopy provides a satisfactory surgical field for trans-oral resection allowing complete resection of the BCC without serious postoperative complications.

Feasibility of transoral endoscopic enucleation for large odontogenic jaw tumors

Objective The aim was to describe a transoral endoscopic approach for large odontogenic jaw tumors and to assess the feasibility of endoscopy in complete enucleation of any tumor remnants. Materials and methods This retrospective cohort study was done on patients presenting with different types of large jaw tumors in the period from 2013 to 2017 at the Department of Otolaryngology – Head and Neck Surgery, Mansoura University, Egypt. All patients were managed endoscopically. with the bony port measured in its largest dimension. Outcome measures were the occurrence of recurrence during the follow up. Follow-up ranged from 6 to 36 months. Results All patients had complete removal of tumor from the cavity with the transoral endoscopic approach through portal opening of the tumor cavity with a mean (SD) of 24.3 (3.12 mm). Various types of odontogenic tumors were included. No recurrence was detected in the follow-up period except for 1 case requiring a second look. Conclusion Management of large jaw tumors varies from incomplete excision as shaving to aggressive excision with greater morbidity requiring reconstruction. Endoscopic transoral route provides a marvelous option that ensures complete excision with functional preservation and less morbidity.

Transoral endoscopic approach versus transcervical with or without mandibular swing approach to parapharyngeal space- a retrospective cohort study in a tertiary care center in Tamil Nadu

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objective of this study was to evaluate and compare patient outcomes and advantages of endoscopic transoral approach to parapharyngeal space with other approaches like transcervical with or without mandibular swing approach.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this retrospective cohort study, we have reviewed 13 cases of parapharyngeal space tumors resected with either trans oral endoscopic assisted approach or external approaches such as trans cervical and mandibular swing approach during the period of June 1, 2015 to May 31, 2020. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 13 cases were included in the study. Among 13 cases, 9 were operated by transoral endoscopic approach, 2 by transcervical approach and 2 by transcervical with mandibular swing approach. Operative time (p=0.048), blood loss (p=0.028), hospital days (p=0.02) and postoperative patient satisfaction (p=0.008) were more in transoral route compared to transcervical route.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Transoral endoscopic route is a safe route of surgery with less morbidity, less complications, less chance of neurovascular injury and cosmetically more acceptable for the patient when compared to open procedures for smaller size tumors without vascularization, present in the upper part of the parapharyngeal space and without attachment to any neurovascular structures.&lt;/p&gt;