The new combined surgical approach for cancer involving the base of tongue-supraglottic complex.

The base of the tongue, valleculae, preepiglottic space, and supraglottic area of the larynx develop from an unpaired central area, i.e., "hypobranchial eminance," unlike oral tongue and vocal cords, which are independently unilateral and paired in character. These areas should be known as "base of tongue-supraglottic complex." Lymphatic criss-cross is common in this area. This paper delineates the usefulness of the combined surgical procedure. The extensive cancer in the base of tongue-supraglottic complex has represented a challenge to the head and neck surgeon. A combined procedure, i.e., supraglottic laryngectomy with a deep and extensive sagittal surgical incision made directly through the lip-mandible-oral tongue, provides wider exposure without severing any major nerves or blood vessels, and the vulnerable bilateral lymph bearing area of the neck can be addressed adequately for elective or curative neck dissection. Preoperative dental assessment, visual and palpatory assessment of tumor extent under anesthesia (EUA) helps in careful patient selection. Rehabilitation is expected to take longer, but not hospitalization, which is understood in surgical resections of this magnitude. The Tata Memorial Hospital experience with this new surgical approach is described in detail.