Tanaka Yuya, Tomifuji Masayuki, Suzuki Hiroshi, Yamashita Taku, Araki Koji, Shiotani Akihiro
Department of Otolaryngology - Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan.
ORL J Otorhinolaryngol Relat Spec. 2014;76(6):357-63. doi: 10.1159/000369626. Epub 2015 Jan 27.
To report the utilization of a new transoral surgery system, i.e. transoral videolaryngoscopic surgery (TOVS) with a navigation system, for the removal of a metastatic retropharyngeal lymph node (RPLN).
An 86-year-old woman with tongue cancer (cT2N0M0) underwent partial glossectomy and left selective neck dissection. Three months postoperatively, a left metastatic RPLN was identified on follow-up magnetic resonance imaging. The metastatic RPLN was successfully excised by TOVS with a navigation system. After postoperative irradiation, she had no recurrence more than 1 year after the surgery.
The retropharyngeal space (RPS) is a difficult area to access surgically. A transcervical approach is conventionally used to access the RPS; however, in the present case, scar tissue after neck dissection may have been problematic. Visualization of the RPS by high-definition endoscopy and a navigation system were effective in facilitating the safe performance of the surgery.
A transoral approach may be a viable choice for surgery of a metastatic RPLN. Surgical indications for a transoral approach to the RPS include that (1) the location of the RPLN is below the level of the hard palate and the pterygoid hamulus and (2) there is only a single lesion, without adhesion to the surrounding tissue.
报告一种新型经口手术系统，即带有导航系统的经口视频喉镜手术（TOVS）在切除转移性咽后淋巴结（RPLN）中的应用。
一名86岁舌癌（cT2N0M0）女性接受了部分舌切除术和左侧选择性颈清扫术。术后3个月，随访磁共振成像发现左侧转移性RPLN。通过带有导航系统的TOVS成功切除了转移性RPLN。术后放疗后，她在手术后1年多未复发。
咽后间隙（RPS）是手术难以到达的区域。传统上采用经颈入路进入RPS；然而，在本病例中，颈清扫术后的瘢痕组织可能存在问题。高清内镜和导航系统对RPS的可视化有助于手术的安全进行。
经口入路可能是转移性RPLN手术的一种可行选择。经口入路至RPS的手术适应证包括：（1）RPLN的位置在硬腭和翼钩水平以下；（2）仅存在单个病变，且与周围组织无粘连。
