V. Sanghvi, THE NEW COMBINED SURGICAL APPROACH FOR CANCER INVOLVING THE BASE OF TONGUE SUPRAGLOTTIC COMPLEX, The Laryngoscope, 104(6), 1994, pp. 725-730
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.