Styloglossus muscle: a critical landmark in head and neck oncology

Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps

Minimally invasive surgery is a growing field in surgical oncology. After acquiring its first Food and Drug Administration approval in 2009 for T1–T2 malignancies of the oral cavity, oropharynx, and larynx, transoral robotic surgery (TORS) has gained popularity thanks to its wristed instruments and magnified three-dimensional view, enhancing surgical comfort in remote-access areas. Its indications are expanding in the treatment of head and neck cancer, i.e., resection of tumors of the larynx, hypopharynx, or parapharyngeal space. However, this expansion must remain cautious and based on high-level evidence, in order to guarantee safety and oncological outcomes which are comparable to conventional approaches. This narrative review assesses the current role of TORS in head and neck cancer from an evidence-based perspective, and then identifies what knowledge gaps remain to be addressed.

Transoral Approach to Parotid Tumors: A Review of the Literature

Different surgical techniques have been proposed for parapharyngeal space tumors, including transcervical, transparotid, trans-mandibular, infratemporal, and transoral. The choice of the correct approach depends on the size, localization and nature of the tumor. The transoral approach can be used for benign prestyloid masses, such as tumors of the deep lobe of the parotid gland. It guarantees a short hospitalization without skin scars. The narrowed access represents the main limitation of this technique. This review will summarize and analyze the current knowledge about the transoral approach to parotid lesions. Thirty-seven studies were included in a qualitative and quantitative synthesis. The novelty of this review is the quantitative analyses of the clinical data reported in the included studies.

Transoral Robotic Surgery for Residual and Recurrent Oropharyngeal Cancers

Transoral robotic surgery (TORS) is a well-established treatment option for treatment-naïve oropharyngeal cancer. For residual, recurrent, and new primary oropharyngeal tumors emerging in previously irradiated fields, the global experience of management with TORS is limited. This article discusses current concepts on this topic, offers a deeper insight into the transoral anatomy for these cases, and covers the specific complexities of resections in the various subsites of the oropharynx. It provides practical tips on reconstruction, recovery, and rehabilitation as well as offering a synthesis of the current evidence and exploring future trends.

Advances in anatomical visualization on the head and neck through robotic surgery: A Brazilian perspective

Trans Oral Robotic Surgery (TORS) is an emerging technique that provides several benefits over existing treatment regimens for head and neck cancer, including smaller incisions, less bleeding, shorter term inpatient hospitalization, and reduced intensive care unit (ICU) length of stay. TORS allows a high resolution, magnified, three-dimensional wide view of the surgical field through an endoscope, avoiding large external cervical incisions and split-lip mandibulotomy, usually required in cancer surgeries of the oropharynx. The anatomy of the Oropharynx viewed from the perspective of the robotic surgeon is different from the anatomy taught in medical schools and residence/fellowship programs, which is more directly related to emergency procedures, open field surgery, and imaging exams. Developing an understanding of the anatomic relationships and landmarks from the "inside out" perspective is critical for any surgeon willing to perform surgical procedures through a transoral robotic approach. Here we address the major anatomic landmarks and structures in head and neck robotic surgeries and advantages and disadvantages of this approach. We emphasize the importance of imaging for successful outcomes, pointing out important anatomic landmarks considered as blind spots for surgeons in clinical and endoscopic evaluations. We also describe the Brazilian current scenario and future perspectives of Robotic Surgery in terms of training and access to this technique, including institutions that currently offer this service in the different regions of Brazil.

From the stylet of the temple to the tongue in so-called Riolan's bouquet

The styloglossus muscle is a key landmark for staging and surgery of certain squamous cell cancers of the oropharynx. The purpose of this historical note is to try to determine when the styloglossus muscle was described for the first time, and to understand its integration into the so-called Riolan's bouquet.

Evaluation of robotic surgery for transoral resection of T1-2 squamous cell carcinoma of the tonsillar fossa

GOAL

To evaluate transoral robotic surgery (TORS) for isolated previously untreated squamous cell carcinoma (SCC) of the tonsillar fossa classified as T1-2.

METHOD

Retrospective analysis of two cohorts of isolated untreated T1-2 tonsillar fossa SCC consecutively operated on by a transoral approach, with (R=21) and without (NR=24) robotic assistance, in the period 2006-2014. Three main (survival, local control, and operative morbidity) and three secondary (pathologic data, incidence and duration of tracheotomy and nasogastric intubation, and hospital stay) endpoints were compared between groups. The significance threshold was set at P< .005.

RESULTS

Three- and five-year actuarial survival estimates were 80.2% and 74.5% respectively in group R, and 91.5% and 82.5% respectively in group NR (NS: P=.34). Three- and five-year actuarial local control estimates were 90% and 90% respectively in group R, and 95.8% and 91% respectively in group NR (NS: P=.81). There were no significant differences in morbidity, tracheotomy/nasogastric intubation time, or hospital stay. Positive resection margins (R1) were noted in 38.1% and 16.7% in groups R and NR, respectively (NS: P=.05) without significant impact on 5-year actuarial local control (P=0.78).

CONCLUSION

Robotic assistance in transoral lateral oropharyngectomy for T1-2 tonsillar fossa SCC did not significantly impact oncologic or functional outcome.