View source for Treatment of tumors of the oropharynx

In the treatment of [[tumors of the oropharynx]], surgery, radiotherapy and their combination are mainly used.

== Surgical approaches ==
=== Oral approach ===
* It is used for small, superficial, exophytically growing [[tumors]], such as [[Tongue - radix (SFLT)|the tongue]], [[floor of the mouth]], palate, uvula or [[Tonsil (specimen)|tonsils]].
* The tumor must be reachable from the mouth, it must not spread to the bottom.
* A CO 2 laser is often used.

=== External access ===
* As a rule, it follows a block dissection of the neck nodes.
* We have two types:

# '''Procedures not cutting [[Mandible|the mandible]]'''
#* '''Pull through''':
#** it is a combined resection from the neck and oral approach.
#* Procedures without resection of the mandible are performed for tumors of the floor of the mouth and root of the tongue.
#* If the alveolar process is affected - a partial mandibulectomy is also performed;
#** is to extract a segment of the process without violating the mandibular shoulder.
#* The resection is extended into the neck surgical wound and removed.
#* '''Lateral pharyngotomy''':
#** is used for the treatment of tumors of the root of the tongue and tonsillar fossa;
#** we penetrate the pharynx behind the big corner of the tongue.
#* '''Medial pharyngotomy (suprahyoid)''':
#** the second traditional procedure;
#** we penetrate just above the tongue in the area of the glossoepiglottic valleculae;
#** most often for small medially located tumors of the root of the tongue.
# '''Procedures violating the continuity of the mandible'''
#* All larger operations.
#* Either it is a temporary resection with subsequent [[Osteosynthesis and its principles|osteosynthesis]] or it is segmentally resected.
#* '''Temporary mandibulotomy''' (mandibular split):
#** the biggest advantage is the clarity of the operating field;
#** may be medial or paramedian (through the foramen mentale) or lateral;
#** good aesthetic result, but the mandible heals poorly with simultaneous radiotherapy.
#* '''The most radical approach''':
#** resection of the lateral segment of the mandible that is in contact with the tumor;
#** in one block together with soft tissues are removed;
#** the jaw moves to the operated side – the occlusion is imperfect, bad chewing;
#** bone reconstruction of the mandible is usually not performed, it will not help functionally.
#* '''Resection of the medial segment''':
#** in extensive base tumors;
#** disastrous aesthetic and functional results → bone reconstruction is done, usually from [[Fibula|the fibula]].

== Therapy of nodal metastases ==
* Part of the treatment of every tumor of the oropharynx.
* Surgically, it is always a block dissection.
* In N0 usually supraomohyoid (area I to III);
** we will remove it and, in case of a positive finding, complete a complete block dissection.

= Links =
==Related articles ==
* [[Tumors of the oropharynx]]
* [[Tumors of the epipharynx]]

== Source ==
* {{Cite
|type = web
|surname1 = Beneš
|name1 = Jiří
|source_name = Studijní materiály
|year = 2007
|cited = 14. 12. 2011
|url = http://jirben2.chytrak.cz/materialy/orl_jb.doc}}
[[Category:Otorhinolaryngology]] [[Category:Oncology|Oncology]]