gms | German Medical Science

Introduction: Transoral laser microsurgery of locally advanced carcinomas of the lateral pharynx often results in an exposure of major vessels of the neck and is accompanied with a substantial risk of intra- and postoperative bleeding. In our hands, these operations are therefore only performed after an external protection of neck vessels and - if necessary - combined with flap reconstruction.

Patients and methods: Between 10/01 and 5/04 five locally advanced squamous cell carcinomas of the lateral oropharynx that radiologically reached the major vessels of the neck, were treated as follows: after ipsilateral neck dissection with temporary protection of the iugular vein and the carotid arteries, the neck remained open, while transoral laser surgery of the primary tumor was performed. Pharyngeal defects were subsequently closed by a platysma myofascial flap. All patients underwent adjuvant radiotherapy.

Results: All primary tumors were completely resected. None of the patients required tracheotomy or placement of a PEG. The mean duration of nasogastric feeding tubes was 15.6 days. In one case, the routine radiological contrast study revealed a blind cervical fistula 10 days after surgery, that healed spontaneously within 7 days. Postoperative bleeding events requiring surgical revision were not observed. During a mean follow up of 18.4 months none of the patients developed a local and/or regional recurrence.

Conclusion: The described surgical procedure ensures a sufficient protection of neck vessels during and after transoral resection of advanced carcinomas of the pharynx. It successfully combines the advantages of minimally invasive laser microsurgery with those of flap reconstruction known from traditional surgery.