Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
BMJ Case Rep. 2020 Oct 22;13(10):e236010. doi: 10.1136/bcr-2020-236010.
A 74-year-old man was referred to a tertiary academic otolaryngology clinic for evaluation of a left-sided neck mass with unknown primary. Nuclear imaging modalities revealed a primary cancer located at the left tongue base. Further investigation revealed the tumour to be a p16 positive squamous cell cancer with metastatic spread to cervical lymph nodes of multiple levels. The patient was found on initial investigation to have microstomia and a retrognathic mandible, which are typically considered unsuitable for robotic surgery due to difficulties obtaining adequate exposure.The patient underwent bilateral neck dissection, followed by transoral robotic-assisted left base of tongue resection. A midline intraoral mandibulotomy was performed to improve robotic access. Following tumour resection, the mandible was repaired using open reduction with internal plate fixation. Postoperative occlusion was maintained, and the patient recovered well from mandibulotomy with none of the morbidity or cosmetic defects associated with a traditional lip-split approach.
一位 74 岁男性因左侧颈部不明原发病灶的肿块，被转诊至一家三级学术耳鼻喉科诊所。核医学成像显示原发灶位于左侧舌底。进一步检查发现肿瘤为 p16 阳性的鳞状细胞癌，已发生多水平的颈部淋巴结转移。初步检查发现患者存在小口畸形和下颌后缩，这通常被认为不适合机器人手术，因为难以获得足够的暴露。患者接受了双侧颈清扫术，随后进行了经口机器人辅助左侧舌底切除术。行中线口内下颌骨切开术以改善机器人手术入路。肿瘤切除后，采用切开复位内固定术修复下颌骨。术后咬合关系得到维持，患者经口内下颌骨切开术恢复良好，无传统唇裂入路相关的发病率或美容缺陷。
