The suprahyoid approach for squamous cell carcinoma of the base of the tongue.

The suprahyoid pharyngotomy is a well-recognized surgical approach to the base of the tongue. However, its use has been widely criticized for squamous cell carcinomas. Some surgeons believe this approach offers limited exposure and that violating the preepiglottic space increases the risk of recurrence. A retrospective study of squamous cell carcinoma of the base of tongue was carried out to address these surgical concerns. Nineteen patients presented with T1 or T2 lesions, 13 of whom underwent suprahyoid pharyngotomy with neck dissection. Those with nodal disease underwent adjunctive irradiation therapy and those with extracapsular spread also received subsequent adjuvant chemotherapy. At present, all patients are disease free. The suprahyoid pharyngotomy is an ideal surgical approach in the management of T1 or T2 squamous cell carcinoma of the base of tongue.     

Total glossectomy for advanced carcinoma of the base of the tongue

The treatment of patients with advanced carcinoma of the base of the tongue is difficult. Selected patients with this lesion can be aided by an aggressive therapeutic approach to this problem. Combined therapy consisting of irradiation therapy followed by composite resection of the entire tongue and larynx and neck dissection may offer the best opportunity for cure or palliation in these patients. Reconstruction of the defect with a non-delayed full forehead flap has provided a very satisfactory floor of the mouth. The postoperative functional abilities of these patients have clearly been compatible with useful life.     

Base of tongue schwannoma: a case report

Both malignant and benign lesions may be found on the base of the tongue, including metastasis from other sites. Various surgical approaches to the base of tongue have been described. Here, we report a case of a 26-year-old woman with a schwannoma in the base of tongue removed through a suprahyoid pharyngotomy approach. The biology and pathology of schwannoma in the oral cavity are discussed. The advantage of the suprahyoid pharyngotomy approach for complete excision of a mass in the base of tongue is demonstrated.     

A case report: Epstein-Barr virus-associated undifferentiated carcinoma of the tongue base

Outside the nasopharynx, undifferentiated carcinomas occur only rarely at other head and neck locations. Although the association between undifferentiated nasopharyngeal carcinoma and Epstein-Barr virus (EBV) is consistent, there is conflicting evidence as to the association of EBV with undifferentiated carcinomas outside the nasopharynx. Here, we report on a case of undifferentiated carcinoma of the tongue base.

A 71-year-old male, who had been treated with irradiation for primary unknown right neck metastatic EBV-positive undifferentiated carcinoma 9 years previously, was referred to our clinic with masses at the tongue base and right neck. The lesion at the tongue base was revealed to be an EBV-positive undifferentiated carcinoma. He was treated with resection of tongue base tumor and bilateral-neck dissection, and the defect at the tongue base was reconstructed with a free rectus abdominis myocutaneous flap. Re-irradiation was added post-operatively because of a positive surgical margin at the tongue base. The patient is presently alive without recurrence or distant metastasis 20 months after treatment.

Although it is unclear whether our case is recurrent or newly developed EBV-latently infected undifferentiated carcinoma, we propose that EBV-associated tumors should be carefully observed after treatment at least for more than 10 years.     

舌根癌的外科治疗

恰当地选择舌根癌外科手术进路，修复肿瘤切除后的缺损，对提高生存率、恢复并保存患者的语言、吞咽等功能是十分必要的。1987～1994年，对23例舌根鳞状细胞癌采取了经咽侧和经下颌骨切开的手术进路，用颈阔肌瓣一期修复舌根咽侧缺损。术后2、3、5年生存情况分别为20／23、13／16、4／7。语言及吞咽功能恢复良好，部分病人因术后放疗致口腔干燥而影响吞咽。根据肿瘤大小、侵袭范围选择手术进路才能充分显露肿物，便于彻底切除，又可避免不必要的损伤。颈阔肌瓣尽管修复面积有限，用于修复部分舌根、咽侧缺损，具有切取方便、距受区近、质地软、成活率高、并发症少等优点。     

Transoral surgical management of lesions of the base of the tongue.

Lesions of the base of the tongue are rare in the pediatric population. However, when present these lesions may lead to airway obstruction and feeding difficulties. Two patients with lesions of the base of the tongue are described to demonstrate the diagnosis and management of this difficult clinical problem. The use of a transoral median glossotomy for total excision of these lesions is advised in this article. This approach affords excellent surgical exposure, early return to a normal diet, and lack of facial scars.     

舌根、咽旁肿瘤外科手术径路比较研究

目的：比较舌根、咽旁肿瘤几种主要手术径路的优缺点，重点分析正中-颌舌沟径路。方法：对41例住院且行外科切除术的舌根、咽旁肿瘤病人的手术方法、手术体会、并发症等进行回顾性研究。结果：口内直接入路、口底舌骨上入路、旁侧入路、正中-颌舌沟入路等4种手术径路皆能满足该区域外科手术的需要，达到完全切除肿瘤和即刻修复的目的。4种径路各具不同的特点。结论：合适的外科径路是舌根和咽旁肿瘤外科手术的关键，正中-颌舌沟径路是一种损伤小、组织保护好的外科径路。     

Resection of cancer of the tongue base and tonsil via the transhyoid approach

OBJECTIVE: To assess whether transhyoid resection of the tongue base and tonsil lesions is an effective approach to tumors involving this region compared with more traditional anterior surgical approaches that arbitrarily involve either segmental resection or division of the mandible. STUDY DESIGN: Retrospective review. METHODS: Since 1988, we have used a combined transhyoid and transoral approach to resect lesions involving the tongue base, tonsil, or both. Forty-one patients were identified who underwent surgical resection of lesions involving this region via this combined approach during this period. A stage-matched group of 41 patients was also identified in which patients underwent resection via traditional composite or mandibulotomy approaches and was used as a basis for comparison. Factors assessed included status of surgical margins, postoperative complications, degree of postoperative dysphagia, and long-term outcome. RESULTS: Comparison between the two groups revealed similar rates of negative surgical margins. Levels of postoperative dysphagia, notably severe primarily in patients with either T4 or recurrent disease, were also similar between groups. Complication rates, especially with regard to fistula occurrence and mandible-healing problems, were significantly lower in the transhyoid group. Analysis of long-term outcome revealed similar patterns with regard to disease status in both groups. CONCLUSIONS: The combined transhyoid and transoral approach is an effective surgical option for a number of lesions affecting the tongue base, tonsil, or both. Although similar to other approaches with regard to postoperative function and disease outcome, the transhyoid approach is associated with decreased postoperative morbidity. However, tumors that extend to involve the mandible or pterygoid musculature or skull base are probably best suited for traditional approaches that involve division of the mandible.     

Submandibular approach for excision of a large schwannoma in the base of the tongue

A 24-year-old Turkish woman is described, who gradually developed progressive swallowing problems over 6 months due to a tumor in the base of the tongue. Magnetic resonance imaging showed a large well-circumscribed solid mass. Histopathological examination of an incisional biopsy showed a schwannoma. The tumor was completely removed through a submandibular approach. The postoperative course was uneventful and her complaints disappeared. The submandibular approach used gave an excellent exposure of the base of tongue with a less obvious scar than a lip-splitting incision. Received: 16 June 1999 / Accepted: 22 July 1999     

Iridium 192 implantation of squamous cell carcinomas of the oropharynx

From 1970 to 1984, 127 patients with T1 or T2 carcinomas of the oropharynx were treated with external irradiation to the primary tumor and neck nodes to a dose of 45 Gy, followed by a further 30 Gy delivered by an iridium 192 implant to the primary tumor. Patients with clinically positive nodes had either further neck irradiation using electrons or a neck dissection. Crude 5-year disease-free survival was 66% for tonsillar carcinomas, 43% for soft palate, and 51% for base of tongue. Local control was 98%, 85%, and 76%, respectively. Regional control was 97% for N0 patients and 88% for N1-3. Soft tissue ulceration occurred in 17 patients; all healed spontaneously. The high rate of local control achieved in these patients while preserving function and minimizing xerostomia supports the use of this approach.     

舌骨咽切开术治疗舌根癌

目的 探讨舌根癌外科治疗的最佳进路和方法。方法通过舌骨咽切开术治疗11例舌根癌,同期行会厌切除者4例,喉水平部分切除者1例。选择性颈清扫术1例,单侧功能性颈清扫术2例,双侧功能性颈清扫术1例,单侧根治性颈清扫术6例,一侧根治性和另一侧功能性颈清扫术1例。结果鳞状细胞癌10例,胚胎性横纹肌肉瘤1例;术后出现咽漏1例,进食流质轻度呛咳1例,上切缘阳性者1例,淋巴结转移者7例;术后拔管率100％;2、3、5年生存率分别为81.8％,77.8％,33.3％。结论 舌骨咽切开进路可清晰暴露舌根、会厌、下咽及喉部,适用于这些部位的肿瘤切除,并发症少。     

达芬奇手术机器人辅助CO2激光切除下咽舌根肿瘤2例

目的 总结达芬奇手术机器人(DVSS)辅助CO2激光在下咽舌根肿瘤切除术中的体会。方法 回顾性分析2例下咽舌根肿瘤患者在DVSS辅助下行CO2激光切除术的临床资料,结合相关文献对该技术的优势和存在问题进行总结。结果 2例患者在DVSS辅助CO2激光下顺利切除肿瘤,术后无明显并发症,恢复良好。结论 DVSS辅助CO2激光切除下咽舌根肿瘤具有术野暴露满意、创伤小、操作方便、术后并发症少及康复时间缩短等优点。     

Management of cancer of the base of tongue

The management of base of tongue cancer has evolved steadily over time. Organ preservation with primary radiation therapy has produced excellent oncologic and functional outcomes. Concomitant chemotherapy has become important in patients with locoregionally advanced disease. Planned neck dissection after organ preservation therapy continues to be an integral step for regional control. This article reports the results of a literature review of base of tongue cancer emphasizing a multidisciplinary approach to obtain optimal results in terms of cure and quality of life.     

Squamous cell carcinoma and lingual thyroid

This report represents the first known case of squamous cell carcinoma associated with lingual thyroid tissue. Clinical examination of an exophytic mass at the base of tongue, CT imaging and a preoperative biopsy established a diagnosis of squamous cell carcinoma of the midline base of tongue. The therapeutic options and management of this carcinoma by surgical resection, irradiation or combined modalities were analyzed. The surgical option was chosen. This was accomplished via a midline labiomandibulo glossal split and primary repair of the wound. The final pathology report revealed a squamous cell carcinoma of the mucosa of the base of tongue directly over a benign lingual thyroid mass. Post-operative thyroid function studies were consistent with hypothyroidism and a thyroid scan confirmed the absence of thyroid tissue.     

悬雍垂腭咽成形术加舌根手术的临床疗效分析

目的 探讨应用悬雍垂腭咽成形术及舌根手术治疗腭-咽平面、舌-平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征。方法 对26例经Muller动作检测确定的因腭-咽平面、舌-咽平面阻塞所致的重度阻塞性睡眠呼吸暂停低通气综合征患者进行了悬雍垂腭咽成形术（uvulopalotopharyngoplasty,UPPP)加舌根手术，其中22例采用激光或电刀的舌根正中做菱形或梭形切除（其中6例舌根加舌根侧缘切开前固定缝合），4例单纯舌根侧缘切开前固定缝合。2例术前做了气管切开术，20例手术时做了气管切开术，全部患者均进行了术前和术后6个月、1年、3年多导睡眠监测。结果 按照杭州会议疗效评定标准，6月内效率100.0%，1年有效率84.6%，3年有效率76.9%,4例患者在1-2年后舌根切除处的凹陷又修复，舌根侧缘切开前固定者在术后短期有进食呛咳问题，锻炼后顺利进食。结论 对阻塞性睡眠呼吸暂停低通气综合征的患者，Muller动作确定阻塞平面是不可缺少的手段；UPPP与舌根手术等综合治疗可能会达到更好疗效。行舌根菱形或梭形切除者，术后应缝合。     

舌根癌的手术治疗

目的：探讨舌根癌的手术治疗方法。方法：舌根癌患者21例，经舌骨咽切开进路11例，下颌骨部分切除进路7例，下唇、下颌骨、舌正中切开进路3例。结果：3例下唇、下颌骨、舌正中切开者出现语言功能障碍，吞咽困难；余18例口腔功能均正常。随访2～5年，失访2例，2年生存18例，3年生存13例，5年生存5例。结论：经舌骨咽切开进路对吞咽功能及语言功能的影响较小，是一种值得推广的术式。     

Hyalinizing clear cell carcinoma arising from the base of the tongue

Hyalinizing clear cell carcinoma is a low-grade indolent and rare salivary gland tumor originally described by Milchgrub et al. in 1994. We herein report a case of this tumor of the base of the tongue. A 66-year-old Japanese woman presented with a large painless mass in the throat. Computed tomography and magnetic resonance imaging revealed a 40×30-mm well-defined ovoid tumor arising from the base of the tongue. She underwent tracheostomy followed by a resection of the tumor via the transmandibular approach combined with a right-sided supra-omohyoid neck dissection. Because the tumor invasion of the surrounding tissue was limited, the surgical defect at the base of the tongue was relatively small, and no reconstructive procedure needed to be performed. The tumor was histopathologically diagnosed as hyalinizing clear cell carcinoma of the minor salivary gland. Her postoperative clinical course was uneventful. No aspiration or difficulty upon deglutition was recognized when she started transoral ingestion on the eighth postoperative day. The patient is currently free from disease 21 months after surgery. The pathology, clinical characteristics, and treatment of hyalinizing clear cell carcinoma are bibliographically reviewed.     

Hyalinizing clear cell carcinoma arising from the base of the tongue

Hyalinizing clear cell carcinoma is a low-grade indolent and rare salivary gland tumor originally described by Milchgrub et al. in 1994. We herein report a case of this tumor of the base of the tongue. A 66-year-old Japanese woman presented with a large painless mass in the throat. Computed tomography and magnetic resonance imaging revealed a 40x30-mm well-defined ovoid tumor arising from the base of the tongue. She underwent tracheostomy followed by a resection of the tumor via the transmandibular approach combined with a right-sided supra-omohyoid neck dissection. Because the tumor invasion of the surrounding tissue was limited, the surgical defect at the base of the tongue was relatively small, and no reconstructive procedure needed to be performed. The tumor was histopathologically diagnosed as hyalinizing clear cell carcinoma of the minor salivary gland. Her postoperative clinical course was uneventful. No aspiration or difficulty upon deglutition was recognized when she started transoral ingestion on the eighth postoperative day. The patient is currently free from disease 21 months after surgery. The pathology, clinical characteristics, and treatment of hyalinizing clear cell carcinoma are bibliographically reviewed.     

Local control of oropharyngeal carcinoma by irradiation alone

The authors of this study reviewed the management of 402 patients with squamous cell carcinomas of the faucial tonsil and the base of the tongue. These patients received radiation therapy at Massachusetts General Hospital and the Massachusetts Eye and Ear Infirmary from 1970 through 1993. Radiation therapy remains the treatment of choice for these lesions. Although the data from this review were not randomized, the accelerated hyperfractionated radiation therapy twice-daily program was shown to achieve significantly higher 5-year local tumor control rates and disease-specific survival rates than the conventional once-daily radiation therapy program (historical control). In patients with early tumors of the faucial tonsil (cancer stages T1 and T2), the 5-year actuarial local tumor control and disease-specific survival rates following the twice-daily radiation therapy program were 91% and 77%, respectively. In patients with advanced tumors (T3), the corresponding rates following twice-daily radiation therapy showed marked improvement and were 80% and 68%. While the treatment results for carcinoma of the base of the tongue generally were inferior to those for carcinoma of the faucial tonsil, they were still much better after the twice-daily program than after conventional once-daily irradiation. For patients with carcinoma of the base of the tongue, the local tumor control and disease-specific survival rates for T1 and T2 lesions were 85% and 76%, respectively. For T3 lesions, the corresponding rates were 54% and 53%. Extensive T4 tumors are better managed by combined surgery and postoperative irradiation. Residual metastatic nodal disease is managed by neck dissection.     

Successful transoral videolaryngoscopic surgery for leiomyoma in the base of the tongue

Leiomyomas are benign tumors with smooth muscle differentiation that occur most frequently in the uterine myometrium. They are uncommon in the head and neck region. We report a rare case of tongue base leiomyoma successfully resected with transoral endoscopic surgery.A 14-year-old male was found to have a tongue base tumor. The tumor located in the right tongue base. It had a smooth surface and no deep invasion. The tumor was resected with transoral videolaryngoscopic surgery. There were no serious adverse events requiring further intervention. Histologically, the tumor was composed of densely cellular fascicles of spindle-shaped cells with smooth muscle differentiation with diffuse and intense reactivity for α-smooth muscle actin, desmin, calponin, and anaplastic lymphoma kinase on immunohistochemistry. After careful consideration of the differential diagnosis, the tumor was diagnosed a smooth muscle tumor, mostly consistent with leiomyoma.This is the first report of leiomyoma arising from the tongue base that was completely resected by transoral videolaryngoscopic surgery without adverse events. For tongue base tumors, endoscopic transoral surgery can be considered as an option for complete resection without impairment of postoperative function.