The surgical plane for lingual tonsillectomy: an anatomic study

Abstract

BackgroundThe presence of a plane between the lingual tonsils and the underlying soft tissue has not been confirmed. The objective of this study is to ascertain the presence and the characteristics about this plane for surgical use.MethodsFive cadaver heads were obtained for dissection of the lingual tonsils. Six permanent sections of previous tongue base biopsies were reviewed. Robot assisted lingual tonsillectomy was performed using the dissection technique from the cadaver dissection.ResultsIn each of the 5 cadavers, an avascular plane was revealed deep to the lingual tonsils. Microscopic review of the tongue base biopsies revealed a clear demarcation between the lingual tonsils and the underlying minor salivary glands and muscle tissue. This area was relatively avascular. Using the technique described above, a lingual tonsillectomy using TORS was performed with similar findings from the cadaver dissections.ConclusionsA surgical plane for lingual tonsillectomy exists and may prove to have a role with lingual tonsillectomy with TORS.

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“…Son described the correct plane in performing lingual tonsillectomy. 10 In Son's resections of the lingual tonsils, there was a relatively less vascular or avascular area between the lingual tonsil and the underlying minor salivary glands and muscle tissue in all cases. Between the lingual tonsil and the submucosal muscular tissue at the base of the tongue, a distinct space or line was demonstrated in both benign and premalignant cases.…”

“…However, in all conditions, dissection between the two layers was feasible based on his histological study. 10 This emphasized the importance of removing all of the lingual tonsil tissue in lingual tonsillectomy especially if the specimen was not going to be examined by Pathologist.…”

“… 7 , 8 , 9 While these techniques destroy the lingual tonsils for benign indications, en bloc resection of the lingual tonsils is required in the workup of head and neck cancer, so that the pathologist can evaluate the tissue under a microscope. 10 The presence of a surgical plane has been questioned in lingual tonsillectomy techniques. Joseph felt that there was a layer of fibrous tissue delineating the lingual tonsils from the tongue.…”

“…The anterior medial edge of a side of the lingual tonsils was grasped and dissection was performed in the lateral posterior direction until the lingual tonsils were removed as one specimen for each side. Care was given to remove the lymphoid tissue keeping the underlying musculature intact 10 …”

“…This potential surgical plane is utilized in lingual tonsillectomy. 10 Son lingual tonsillectomy in 2016 using the robot. The lingual tonsil tissue was removed down to the muscle layer, starting medially, and dissecting laterally.…”