Skip to main content

Advertisement

SpringerLink
Log in

Mini-invasive lateral oropharyngectomy for T3–T4a oropharyngeal cancer

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Mandibular swing is the approach of choice for resection of advanced oropharyngeal carcinomas without bone involvement. This approach requires a mandibulotomy, which is associated with complications. A prospective outcome analysis was performed for 21 patients operated without mandibulotomy for T3–T4a oropharyngeal carcinoma. Tumour size was categorized as T3 in 14 patients (66.7 %) and as T4a (33.3 %) in 7 patients. Twelve patients were N0 (57.1 %), 2 (9.5 %) were N1, and 7 (33.3 %) were N2. Surgical margins were negative in 18 cases (85.7 %), positive in 1 (4.8 %), and close in 2 (9.5 %). Average hospital stay was 14.5 days (range 10–22). Adjuvant treatment (radiotherapy or concurrent chemoradiotherapy) was administered to all but three patients previously irradiated. In all cases radiotherapy started within 42 days of surgery. The 3-year overall survival was 85.7 %, and relapse-free survival was 71.4 %. Oropharyngectomy without mandibulotomy has the same indications as mandibular swing. It provides good access to achieve satisfactory clearance of tumours, sparing patients the morbidity associated with mandibulotomy.

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
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Haigentz M Jr, Silver CE, Corry J, Genden EM, Takes RP, Rinaldo A, Ferlito A (2009) Current trends in initial management of oropharyngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 266:1845–1855

    Article  PubMed  Google Scholar 

  2. Quon H, Yom SS, Garg MK, Lawson J, McDonald MW, Ridge JA, Saba N, Salama J, Smith R, Yeung AR, Beitler JJ (2010) ACR appropriateness criteria: local-regional therapy for resectable oropharyngeal squamous cell carcinomas. Curr Probl Cancer 34:175–192

    Article  PubMed  Google Scholar 

  3. Daly ME, Le QT, Maxim PG, Loo BW Jr, Kaplan MJ, Fischbein NJ, Pinto H, Chang DT (2010) Intensity-modulated radiotherapy in the treatment of oropharyngeal cancer: clinical outcomes and patterns of failure. Int J Radiat Oncol Biol Phys 76:1339–1346

    Article  PubMed  Google Scholar 

  4. Basterra J, Bagan JV, Zapater E, Armengot M (1998) Pull-through oropharyngectomy in advanced stage malignant tumours. J Laryngol Otol 112:355–359

    Article  PubMed  CAS  Google Scholar 

  5. Basterra J, Bagan JV, Alba JR, Frias S, Zapater E (2007) Oropharyngectomy without mandibulotomy in advanced stage (T3–T4) oropharyngeal cancer. Acta Otolaryngol 127:874–879

    Article  PubMed  CAS  Google Scholar 

  6. Park YM, Lee JG, Lee WS, Choi EC, Chung SM, Kim SH (2009) Feasibility of transoral lateral oropharyngectomy using a robotic surgical system for tonsillar cancer. Oral Oncol 45:e62–e66

    Article  PubMed  Google Scholar 

  7. Société Française d’Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou (2006) Suivi post-thérapeutique des carcinomes epidermoïdes des voies aérodigestives supérieures de l’adulte. Available: http://www.orlfrance.org/article.php?id=20

  8. Green FLPD, Fleming ID et al (2002) AJCC Cancer staging manual, 6th edn. Springer, New York

    Google Scholar 

  9. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    Article  PubMed  CAS  Google Scholar 

  10. Davidson J, Freeman J, Birt D (1989) Mandibulotomy in the irradiated patient. Arch Otolaryngol Head Neck Surg 115:497–499

    Article  PubMed  CAS  Google Scholar 

  11. Dubner S, Spiro RH (1991) Median mandibulotomy: a critical assessment. Head Neck 13:389–393

    Article  PubMed  CAS  Google Scholar 

  12. Sullivan PK, Fabian R, Driscoll D (1992) Mandibular osteotomies for tumor extirpation: the advantages of rigid fixation. Laryngoscope 102:73–80

    Article  PubMed  CAS  Google Scholar 

  13. Christopoulos E, Carrau R, Segas J, Johnson JT, Myers EN, Wagner RL (1992) Transmandibular approaches to the oral cavity and oropharynx. A functional assessment. Arch Otolaryngol Head Neck Surg 118:1164–1167

    Article  PubMed  CAS  Google Scholar 

  14. Shah JP, Kumaraswamy SV, Kulkarni V (1993) Comparative evaluation of fixation methods after mandibulotomy for oropharyngeal tumors. Am J Surg 166:431–434

    Article  PubMed  CAS  Google Scholar 

  15. McCann KJ, Irish JC, Gullane PJ, Holmes H, Brown DH, Rotstein L (1994) Complications associated with rigid fixation of mandibulotomies. J Otolaryngol 23:210–215

    PubMed  CAS  Google Scholar 

  16. Smeele LE, Slotman BJ, Mens JW, Tiwari R (1999) Local radiation dose, fixation, and non-union of mandibulotomies. Head Neck 21:315–318

    Article  PubMed  CAS  Google Scholar 

  17. Eisen MD, Weinstein GS, Chalian A, Machtay M, Kent K, Coia LR, Weber RS (2000) Morbidity after midline mandibulotomy and radiation therapy. Am J Otolaryngol 21:312–317

    Article  PubMed  CAS  Google Scholar 

  18. Bertrand J, Luc B, Philippe M, Philippe P (2000) Anterior mandibular osteotomy for tumor extirpation: a critical evaluation. Head Neck 22:323–327

    Article  PubMed  CAS  Google Scholar 

  19. Genty E, Marandas P, Beautru R, Schwaab G, Luboinski B (2001) Mandibulotomy for cancer of the oral cavity and oropharynx: functional and carcinologic outcome in 107 cases. Ann Otolaryngol Chir Cervicofac 118:26–34

    PubMed  CAS  Google Scholar 

  20. Dai TS, Hao SP, Chang KP, Pan WL, Yeh HC, Tsang NM (2003) Complications of mandibulotomy: midline versus paramidline. Otolaryngol Head Neck Surg 128:137–141

    Article  PubMed  Google Scholar 

  21. Uglesic V, Knezevic P, Kosutic D, Jokic D (2004) Lag screw fixation for straight midline mandibulotomy: four-year experience. Ann Plast Surg 52:349–353

    Article  PubMed  Google Scholar 

  22. Dziegielewski PT, Mlynarek AM, Dimitry J, Harris JR, Seikaly H (2009) The mandibulotomy: friend or foe? Safety outcomes and literature review. Laryngoscope 119:2369–2375

    Article  PubMed  Google Scholar 

  23. Nam W, Kim HJ, Choi EC, Kim MK, Lee EW, Cha IH (2006) Contributing factors to mandibulotomy complications: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:e65–e70

    Article  PubMed  Google Scholar 

  24. Riddle SA, Andersen PE, Everts EC, Cohen JI (1997) Midline mandibular osteotomy: an analysis of functional outcomes. Laryngoscope 107:893–896

    Article  PubMed  CAS  Google Scholar 

  25. Zeitels SM, Vaughan CW, Ruh S (1991) Suprahyoid pharyngotomy for oropharynx cancer including the tongue base. Arch Otolaryngol Head Neck Surg 117:757–760

    Article  PubMed  CAS  Google Scholar 

  26. IJsselstein CB, Hovius SE, ten Have BL, Wijthoff SJ, Sonneveld GJ, Meeuwis CA, Knegt PP (1996) Is the pectoralis myocutaneous flap in intraoral and oropharyngeal reconstruction outdated? Am J Surg 172:259–262

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

Authors state that this study has been approved by the Montpellier Universitary Teaching Hospital ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All persons gave their informed consent prior to their inclusion in the study.

Author information

Authors and Affiliations

  1. Department of Head and Neck Surgery, CHU, Montpellier, France

    Pierfrancesco Pelliccia, Marcos Martinez Del Pero , Mohammad Al Felasi, Michael Bartolomeo & Marc Makeieff

  2. Department of Maxillo-Facial Surgery, University of Rome La Sapienza, Rome, Italy

    Pierfrancesco Pelliccia & Giorgio Iannetti

  3. Department of Otorhinolaryngology, JPUH, Great Yarmouth, UK

    Marcos Martinez Del Pero

  4. Department of Medical Information, CHU, Montpellier, France

    Grégoire Mercier

  5. Service ORL Chirurgie Cervico-Faciale CHU Montpellier, 80, Avenue Augustin Fliche, 34295, Montpellier, France

    Marc Makeieff

Authors
  1. Pierfrancesco Pelliccia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcos Martinez Del Pero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Grégoire Mercier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammad Al Felasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giorgio Iannetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Bartolomeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marc Makeieff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc Makeieff.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pelliccia, P., Martinez Del Pero , M., Mercier, G. et al. Mini-invasive lateral oropharyngectomy for T3–T4a oropharyngeal cancer. Eur Arch Otorhinolaryngol 270, 1419–1425 (2013). https://doi.org/10.1007/s00405-012-2158-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-012-2158-5

Keywords

Search

Navigation