Transoral robotic submandibular gland transposition to reconstruct radical tonsillar resection defects

Abstract

Significant dysphagia, pain, and risk of bleeding occur after transoral robotic surgery (TORS) radical tonsillectomy. We present a novel surgical technique utilizing robotically assisted submandibular gland transposition (SMGT) to reconstruct the radical tonsillar defect. A 48‐year‐old male with p16+ tonsillar squamous cell carcinoma underwent deep TORS radical tonsillectomy, contralateral tonsillectomy, ipsilateral neck dissection, and TORS‐assisted reconstruction of the radical defect with ipsilateral SMGT. Postoperatively, the patient experienced minimal pain and was discharged on postoperative day (POD) 3 tolerating a soft diet. There were no episodes of postoperative bleeding. This procedure was performed in five other cases as well. Transoral robotic SMGT can be used successfully to repair deep TORS radical tonsillectomy defects and may theoretically reduce dysphagia, pain, and the risk of hemorrhage.

Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

“…Of these, 51 articles were reviewed in full following screening and removal of duplicates. A total of 26 final studies met inclusion based on appropriateness of patient population, intervention performed, and outcome of interest adequately specified 15–40 . One study detailing reconstructive strategies of TORS defects was excluded due to lack of description regarding specific reconstructive modalities used in the patient cohort described 11 .…”

“…Multiple other free and local flaps, such as ALT, FAMM, vastus lateralis, rectus femoris, temporalis, and infrahyoid myocutaneous flaps have been successfully employed. Recently described techniques such as SMGT, free jejunal flaps, and nasoseptal flaps for coverage of TORS defects may increase in prevalence as these techniques becomes more widely adopted 37,40,47 …”

“…Recently described techniques such as SMGT, free jejunal flaps, and nasoseptal flaps for coverage of TORS defects may increase in prevalence as these techniques becomes more widely adopted. 37,40,47 Surgical outcomes of the different reconstructive techniques cannot yet be quantitatively compared; current literature generally indicates favorable prognosis following reconstruction after TORS, with very low rates of PCF formation, bleeding, chyle leaks, and infection, and minimal reconstruction failures leading to additional intervention. In our experience, though arterial ligation following TORS has been demonstrated to decrease severity of post-TORS hemorrhage, we do not find vessel ligation to be necessary in the setting of free flap reconstruction.…”

“…The average hospital LOS was 12 days, ranging from 2 days in a patient undergoing submandibular gland transposition (SMGT) for coverage of a TORS tonsillar resection defect, to 52 days for a patient who underwent ALT free flap reconstruction after CXRT failure. 25,40 Of 260 patients, 186 (71.5%) were documented as returning to complete oral diet at the last date of follow-up with no dependence on nasogastric feeding or gastrostomy tube. Only three studies quantitatively assessed swallowing performance postoperatively using the MDADI or functional outcomes of swallowing scale (FOSS) among patients undergoing reconstruction of TORS defects.…”

Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema With Resultant Airway Obstruction Following Endotracheal Intubation

“…The surgeon also has more flexibility and control of the force of the balloon, making this an advantageous procedure compared to alternative dilatation instruments [19]. In instances where tracheal stenosis is unresponsive to balloon dilation (which is a more conservative treatment option), tracheal resection is performed; resection is reported to have a success rate of 71-95% [20]. However, contraindications to tracheal resection include tracheal stenosis that requires resection of over half the trachea; this may create additional tension upon closure.…”