Computed tomographic angiography with three-dimensional reconstruction for transoral laser microsurgery.

OBJECTIVE

To identify major arteries in relationship to large pharyngeal tumors during transoral laser microsurgery.

STUDY DESIGN

Case series with planned data collection.

SETTING

Mayo Clinic, Jacksonville, Florida.

SUBJECTS AND METHODS

We developed a new technique that combines three-dimensional CT angiography and enhanced soft-tissue neck CT for evaluation of pharyngeal tumors before transoral laser microsurgery. Data from CT angiography were used to create three-dimensional images of the tumor and adjacent arterial branches to better orient the surgeon to the spatial relationships of major arteries and pharyngeal tumors. Included were selected patients who had large tumors involving the pharynx and who underwent transoral laser microsurgery.

RESULTS

Eighteen patients were studied from June 2008 through January 2009. Tumor enhancement was absent or modest in four of 18 patients. Three of these four patients had superficial squamous cell carcinomas and one had adenoid cystic carcinoma. The remaining 14 patients had good tumor enhancement. The tumor involved the lingual artery in three and displaced the lingual or facial artery in two of these 14 patients. One anomalous right inferior thyroid artery was identified. Compared with routine enhanced soft-tissue neck CT, three-dimensional CT angiography greatly enhanced the anatomical relationships of the major arteries. In one patient, the surgeon's approach was changed after three-dimensional CT angiography demonstrated an encased lingual artery.

CONCLUSION

Three-dimensional CT angiography was useful in identifying the anatomical orientation of major arteries and the planning of transoral laser microsurgery to treat tumors involving the pharynx.