Head and Neck

  • Jesse Creed SelberEmail author


Access to many oropharyngeal tumors has traditionally been through a transmandibular, translabial approach or a wide pharyngotomy. Unfortunately, mandibulotomies and large phayngotomies can result in significant postoperative morbidity and functional and esthetic compromise. Because of the morbidity involved in these more aggressive resections and the proven efficacy of chemoradiation in the treatment of some oropharyngeal cancer, there was a paradigm shift away from ablative surgery. As long-term follow-up on these “organ-sparing” protocols has taken shape, however, significant morbidity and mortality has emerged. Transoral robotic surgery (TORS) was developed to resect tumors in the oropharynx without splitting the mandible. It has the benefits of locoregional control while avoiding the morbidity of high-dose chemoradiation therapy. The reconstructive challenge created by these minimally invasive resections is that the cylinder of the oropharynx remains almost entirely closed, severely restricting access to oropharyngeal anatomy. For these types of defects, transoral inset of a free flap or local flap using robotic assistance has been shown to be both feasible and effective. By taking this approach, the plastic surgeon can provide the reconstructive support for the head and neck surgeon to remove larger and more complex tumors robotically that would be very difficult to reconstruct through traditional methods.


Oropharyngeal Cancer Needle Driver Microvascular Anastomosis Transoral Robotic Surgery Invasive Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Campbell BH, Spinelly K, Marbella AM et al (2004) Aspiration, weight loss, and quality of life in head and neck survivors. Arch Otolaryngol Head Neck Surg 130:1100–1103PubMedCrossRefGoogle Scholar
  2. 2.
    Forastiere AA, Goepfert H, Maor M et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091–2098PubMedCrossRefGoogle Scholar
  3. 3.
    Genden EM, Desai S, Sung CK (2009) Transoral robotic surgery for the management of head and neck cancer: a preliminary experience. Head Neck 31:283–289PubMedCrossRefGoogle Scholar
  4. 4.
    Kotz T, Costello R, Li Y, Posner MR (2004) Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck. Head Neck 26:365–372PubMedCrossRefGoogle Scholar
  5. 5.
    Machtay M, Rosenthal DI, Hershock D, Penn Cancer Center Clinical Trials Group et al (2002) Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: a University of Pennsylvania Phase II Trial. J Clin Oncol 20:3964–3971PubMedCrossRefGoogle Scholar
  6. 6.
    O’Malley BW, Weinstein GS, Snyder W et al (2006) Trans-oral robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope 116:1465–1472PubMedCrossRefGoogle Scholar
  7. 7.
    Ozer E, Waltonen J (2008) Trans-oral robotic nasopharyngectomy: a novel approach for nasopharyngeal lesions. Laryngoscope 118:1613–1616PubMedCrossRefGoogle Scholar
  8. 8.
    Park YM, Lee WJ, Lee JG, Chi EC et al (2009) Trans-oral robotic surgery (TORS) in laryngeal and hypopharyngeal cancer. J Laparoendosc Adv Surg Tech A 19:361–368PubMedCrossRefGoogle Scholar
  9. 9.
    Rademaker AW, Vonesh EF, Logemann JA et al (2003) Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12-month follow-up study accounting for dropout. Head Neck 25:1034–1041PubMedCrossRefGoogle Scholar
  10. 10.
    Roh JL, Kim AY, Cho MJ (2005) Xerostomia following radiotherapy of the head and neck. J Clin Oncol 23:3016–3023PubMedCrossRefGoogle Scholar
  11. 11.
    Selber JC (2010) Trans oral robotic reconstruction of oropharyngeal defects: a case series. Plast Reconstr Surg 126:1978–1987PubMedCrossRefGoogle Scholar
  12. 12.
    Selber JC, Robb G, Serletti JM et al (2010) Transoral robotic free flap reconstruction of oropharyngeal defects: a preclinical investigation. Plast Reconstr Surg 125:896–900PubMedCrossRefGoogle Scholar
  13. 13.
    The Department of Veterans Affairs Laryngeal Cancer Study Group (1991) Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced ­laryngeal cancer. N Engl J Med 324:1685–1690CrossRefGoogle Scholar
  14. 14.
    Weinstein GS, O’Malley BW Jr, Snyder W et al (2007) Trans-oral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg 133:1220–1226PubMedCrossRefGoogle Scholar
  15. 15.
    Weinstein GS, O’Malley BW Jr, Snyder W et al (2007) Trans-oral robotic surgery: supraglottic partial laryngectomy. Ann Otol Rhinol Laryngol 116:19–23PubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Department of Plastic Surgery – Unit 1488, Anderson Cancer CenterThe University of Texas, M.D.HoustonUSA

Personalised recommendations