Chia Clemente, Sharp Samuel, Zhang Henry, Magarey Matthew J R
Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
Department of Otolaryngology Head and Neck Surgery, Barts Health NHS Trust, Royal London Hospital, London, UK.
Laryngoscope. 2025 Jul;135(7):2399-2402. doi: 10.1002/lary.32025. Epub 2025 Jan 29.
Transoral robotic surgery (TORS) and transoral laser microsurgery (TOLM) plus neck dissection are viable alternatives to radiotherapy as a treatment modality in select cases of oropharyngeal squamous cell carcinoma. Many centers advocate for elective ligation of the feeding arteries at index neck dissection prior to TORS/TOLM to mitigate the risk of catastrophic perioperative hemorrhage. Although there are multiple cadaveric studies in the literature to identify the lingual artery at multiple points throughout its course, there are no studies on the intraoperative identification of the lingual artery for elective ligation prior to TORS/TOLM.
A retrospective review of all patients undergoing neck dissection with vessel ligation prior to TORS. Lingual artery was identified at its origin, and relation to hypoglossal nerve was recorded. Patient demographics, intraoperative findings including the relation between lingual artery and hypoglossal nerve measured in millimeters, and postoperative complications were extracted from medical records.
Of the 33 cases eligible for this study, the lingual artery was identified directly deep to the hypoglossal nerve in 21 cases (63.6%). Of the remaining cases, seven were within 5 mm inferior to the hypoglossal nerve (21.2%), and only two cases (6.1%) were identified superior to the hypoglossal nerve.
The hypoglossal nerve is a useful landmark for the intraoperative identification of the lingual nerve in elective neck dissection prior to TORS. The lingual artery can be identified either immediately deep to or within 5 mm inferior to the hypoglossal nerve in majority of cases.
4 Laryngoscope, 135:2399-2402, 2025.
经口机器人手术（TORS）和经口激光显微手术（TOLM）加颈部清扫术是某些口咽鳞状细胞癌病例中放疗的可行替代治疗方式。许多中心主张在TORS/TOLM之前的初次颈部清扫术中选择性结扎供血动脉，以降低围手术期灾难性出血的风险。尽管文献中有多项尸体研究在舌动脉全程的多个点识别舌动脉，但尚无关于TORS/TOLM之前选择性结扎术中识别舌动脉的研究。
回顾性分析所有在TORS之前接受颈部清扫并结扎血管的患者。在舌动脉起源处识别舌动脉，并记录其与舌下神经的关系。从病历中提取患者人口统计学资料、术中发现（包括以毫米为单位测量的舌动脉与舌下神经之间的关系）以及术后并发症。
在符合本研究条件的33例病例中，2l例（63.6%）舌动脉直接位于舌下神经深面。其余病例中，7例位于舌下神经下方5mm以内（~21.2%），仅2例（6.1%）位于舌下神经上方。
舌下神经是TORS之前选择性颈部清扫术中识别舌动脉的有用标志。在大多数情况下，舌动脉可在舌下神经深面或其下方5mm以内识别。
4 《喉镜》，135:2399 - 2402，2025年。
