Skip to main content
SpringerLink
Log in

Radiological and cadaveric study of anatomical safe zone for transoral base of tongue surgery

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

The aim of this study is to identify a surgical safe zone in base of tongue surgery. Fifteen Fresh frozen cadavers (30 head and neck regions) were included in the anatomical study. Twenty-two CT-angiogram (CTA) scans of neck were included in the radiological study. Surgical safe zone for base of tongue surgery was studied in cadavers and correlated the same in CTA. Depth of the lingual artery (LA) from the tongue surface and distance of origin of lingual artery from tip of greater cornu of hyoid bone was significantly different when comparing anatomical to radiological study (p < 0.005). On protruded position of tongue, lingual artery appeared more close to the tongue surface and was never encountered posterior to foramen caecum. Preoperative CTA evaluation would over-estimate the depth of LA putting the lingual artery at risk during resection. A surgical safe zone exists posterior to foramen caecum and towards the midline.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dallan I, Seccia V, Faggioni L et al (2013) Anatomical landmarks for transoral robotic tongue base surgery: comparison between endoscopic, external and radiological perspectives. Surg Radiol Anat 35(1):3–10

    Article  Google Scholar 

  2. Tirelli G, Boscolo Nata F, Piovesana M, Quatela E, Gardenal N, Hayden RE (2018) Transoral surgery (TOS) in oropharyngeal cancer: different tools, a single mini-invasive philosophy. Surg Oncol 27:643–649

    Article  Google Scholar 

  3. Hou T, Shao J, Fang S (2012) The definition of the V zone for the safety space of functional surgery of the tongue. Laryngoscope 122:66–70

    Article  Google Scholar 

  4. Wu D, Qin J, Guo X, Li S (2014) Analysis of the difference in the course of the lingual arteries caused by tongue position change. The Laryngoscope 125(3):762–766

    Article  Google Scholar 

  5. Lemaire V, Jacquemin G, Nelissen X et al (2005) Tip of the greater horn of the hyoid bone: a landmark for cervical surgery. Surg Radiol Anat 27:33

    Article  CAS  Google Scholar 

  6. Lopez R, Lauwers F, Paoli J, Boutault F, Guitard J (2007) Vascular territories of the tongue: anatomical study and clinical applications. Surg Radiol Anat 29(3):239–244

    Article  CAS  Google Scholar 

  7. Moore E, Janus J, Kasperbauer J (2011) Transoral robotic surgery of the oropharynx: clinical and anatomic considerations. Clin Anat 25(1):135–141

    Article  Google Scholar 

  8. Lauretano AM, Li KK, Caradonna DS, Khosta RK, Fried MP (1997) Anatomic location of the tongue base neurovascular bundle. Laryngoscope 107:1057–1059

    Article  CAS  Google Scholar 

  9. Hou T, Zhou L, Hu H (2011) Computed tomographic angiography study of the relationship between the lingual artery and lingual markers in patients with obstructive sleep apnoea. Clin Radiol 66(6):526–529

    Article  Google Scholar 

  10. Ye J, Wang J, He L, Han D (2001) Anatomic characteristics of lingual artery and midline glossectomy. Chin J Otorhinolaryngol 36:55–57

    CAS  Google Scholar 

  11. Li S, Shi H (2013) Lingual artery CTA-guided midline partial glossectomy for treatment of obstructive sleep apnea hypopnea syndrome. Acta Otolaryngol 133(7):749–754

    Article  Google Scholar 

  12. Li Sh, Shi HJ, Wu DH, Bao JM, Yang BQ, Dong WD et al (2009) Study of lingual arterial CT angiography and security of partial glossectomy in obstructive sleep apnea hypopnea syndrome. Chin J Otorhinolaryngol 44:831–836

    Google Scholar 

  13. Cohen D, Low G, Melkane A et al (2016) Establishing a danger zone: an anatomic study of the lingual artery in base of tongue surgery. The Laryngoscope 127(1):110–115

    Article  Google Scholar 

Download references

Funding

Nil.

Author information

Authors and Affiliations

  1. Department of ENT-HNS, Apollo Hospitals, Opp. IIM, Bannerghatta Road, Bangalore, 560076, Karnataka, India

    Ameena Ibrahim, Swetha Kumar, J. G. Aishwarya, Ashish S. Shah & Satish Nair

  2. Department of Radiodiagnosis, Apollo Hospitals, Bangalore, Karnataka, India

    Aruna R. Patil

Authors
  1. Ameena Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Swetha Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aruna R. Patil
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. G. Aishwarya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ashish S. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Satish Nair
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SN: substantial contributions to the conception or design of the work, revising it critically for important intellectual content, analysis and interpretation of data for the work and drafting the work and final approval of the version to be published. AI, SK: substantial contributions to the acquisition of data for the work, revising it critically for important intellectual content and final approval of the version to be published. ARP: substantial contributions to the acquisition of radiological data for the work. JGA, ASS: substantial contributions to the acquisition of data for the work.

Corresponding author

Correspondence to Satish Nair.

Ethics declarations

Conflict of interest

Dr. Ameena Ibrahim, Dr. Swetha Kumar, Dr. Aruna R Patil, Dr. J. G. Aishwarya, Dr. Ashish S. Shah and Dr Satish Nair declare that they have no conflict of interest/competing interests.

Ethical approval

Obtained.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Data availability

Available with the corresponding author and will be presented on special request.

Code availability

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ibrahim, A., Kumar, S., Patil, A.R. et al. Radiological and cadaveric study of anatomical safe zone for transoral base of tongue surgery. J Robotic Surg 15, 711–716 (2021). https://doi.org/10.1007/s11701-020-01164-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-020-01164-6

Keywords

Search

Navigation