Transoral Biopsy: Surgical Technique

Abstract

Transoral biopsy is harvesting tissue samples for histological and/or bacteriological study from the craniocervical transition area. It is indicated in suspected cases of inflammatory and tumor destructive processes that are located behind the posterior wall of the pharynx. Transoral biopsy can be conducted as an independent surgical manipulation or as a stage of a surgical intervention in which a cytological conclusion might influence the tactics of the operation. The manipulation requires a special mouth retractor and a C-arm or O-arm radiographic image systems. Special importance is paid to correct patient’s positioning and surgeon’s working location. Biopsy is performed from either an open or closed approach. The vertical approach area includes the lower part of the occipital bone clivus, the anterior C1 arch, C2 odontoid process and body, C2–C3 disc, C3 upper body portion, anterior (axial) C1–C2 joint, anterior epidural space of the craniovertebral transition area, and upper cervical spine down to C3. An 11-mm distance on both sides from the midline is a horizontal approach area. Main complications and risks are bleeding, injury to the dura mater, liquorrhea, meningitis, dehiscence of the pharyngeal sutures, and wound infection.