Surgical Approaches to the Oropharynx

  • Transoral:
    • True Transoral
    • Exposure via Pull-through
    • Exposure via Mandibulotomy 
  • Transcervical:
    • Pharyngotomy:
      • Lateral pharyngotomy
      • Suprahyoid pharyngotomy
    • Laryngotomy
    • Laryngectomy
  • Transoral approach:
    • Indications:
      • Lesions of the:
        • Faucial arches
        • Tonsils
        • Upper posterior pharyngeal wall
      • Small lesions equal or less than 1.5 cm
    • Can be combined with other approaches
    • Advantages:
      • Simple
      • Mandible intact
      • Flexible
    • Disadvantage: 
      • Limited exposure
  • Pull-through approach:
    • Bilateral level I (at least) neck dissections
    • Identification of hypoglossal nerve and lingual nerve
    • Floor of mouth mucosa and extrinsic tongue muscles are divided:
      • Dropping the tongue into the neck
    • Lingual nerve and sublingual gland are kept with the mandible 
    • Advantages:
      • Better exposure than true trans oral
      • Intact lip sensation
      • Good facial cosmesis
      • Intact mandible
    • Disadvantages:
      • Exposure
      • Lingual nerve is divided
      • Bleeding
      • May need additional approach

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