The transhyoid approach to the oropharynx

In the past 20 years, there has been a trend toward mandible-sparing approaches to the resection of oropharyngeal carcinomas. A common approach to achieve this is the mandibular swing procedure. Although this approach provides wide exposure of the oropharynx, it exposes the patient to risks of oral scarring and mandibular osteomyelitis, osteoradionecroses, malunion, or nonunion. An alternative is the transhyoid approach. In this procedure, the tumor is initially visualized by entering the pharynx on the less involved side of the vallecula. The mandible is released and retracted superiorly. As the inferior portions of the resection are performed, exposure to the superior aspects of the tumor are obtained. A limited posterior mandibulectomy can be performed from below if the mandible is involved. One study has documented lower rates of complications relative to the mandibular osteotomy using the transhyoid approach. The transhyoid approach produced complication rates equivalent to those of transmandibular approaches when multiple other variables were examined. I advocate the transhyoid approach for oropharyngeal tumors that involve a portion of the tongue base and do not extend significantly into the nasopharynx, pterygoid muscles, or superior parapharyngeal space.