THE NEW COMBINED SURGICAL APPROACH FOR CANCER INVOLVING THE BASE OF TONGUE SUPRAGLOTTIC COMPLEX

The base of the tongue, valleculae, preepiglottic space, and supraglot tic area of the larynx develop from an unpaired central area, i.e., '' hypobranchial eminance,'' unlike oral tongue and vocal cords, which ar e 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 t ongue-supraglottic complex has represented a challenge to the head and neck surgeon. A combined procedure, i.e, supraglottic laryngectomy wi th a deep and extensive sagittal surgical incision made directly throu gh the lip-mandible-oral tongue, provides wider exposure without sever ing any major nerves or blood vessels, and the vulnerable bilateral ly mph bearing area of the neck can be addressed adequately for elective or curative neck dissection. Preoperative dental assessment, visual an d 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 o f this magnitude. The Tata Memorial Hospital experience with this new surgical approach is described in detail.