[Transhyoid bucopharyngectomy: a new surgical approach to oropharyngeal tumours].

OBJECTIVES

To present a new surgical technique for oropharyngeal tumours. We describe the technique together with the indications, limits and pitfalls.

SURGICAL TECHNIQUE: Transverse cervical collar incision. Bilateral neck dissection according to patient's nodal status. Infrahyoide muscles dissection from the posterior-inferior surface of the hyoid bone body. Division of this structure bilateraly at it junction with greater corns. Push back and up of the hyoid bone together with its suprahyoid muscles upon the mandible. Incision of the mouth floor Push down of the tongue to the cervical region. Tumour bloc resection with optimal exposure. Wound closure with or without reconstruction according to the size of surgical defect. Reposition of the hyoid bone and suprahyoid muscles in place, and suture of infrahyiod muscles to hyoid bone. Neck closure. Transitory tracheotomy. MAIN INDICATIONS: T2-3 of tongue base and vallecula, T2-3 of tonsil.

DISCUSSION: Surgical therapy, alone or integrated in a multimodality program, maintains an essential role in the management of patients with oropharyngeal tumours. In locally advanced tumours transmandibular approach is the method usually employed. Despite the wide surgical exposure, this approach may cause significant morbidity secondary to mandibular interruption. To avoid this, mandible-sparing procedures as suprahyoid, transhyoid and transpharyngeal approaches are advocated, but usually need complex manoeuvres and don't allow a large field for resection. These problems can be solved with the described technique we called transhyoid bucopharyngectomy.

CONCLUSION

Transhyoid bucopharyngectomy is an easy and safe procedure for head and neck surgeons, offers an acceptable level of postoperative swallowing and speech function, without the morbidity associated with transmandibular approaches, besides providing a good and wide exposure of the tumour to be removed. Bone invasion is the most important limit for this technique.