Resection of carcinomas of the oropharynx and nasopharynx: A new approach

A new operation based on the concept of the pullthrough resection for mouth cancers and utilizing a posterior pharyngotomy approach for exposure has been developed for the surgical treatment of carcinomas of the oropharynx and nasopharynx. The operation has been used on six patients with a variety of extensive carcinomas of the pharynx. Three patients had lesions involving primarily the lateral pharyngeal wall, tonsillar fossa, and base of tongue; one patient had an extensive tumor involving the base of tongue bilaterally; one patient had a large carcinoma of the soft palate, tonsillar fossa, and nasopharynx; and the last patient had three primary carcinomas, one in the posterolateral pharyngeal wall, one in the tonsillar fossa, and one in the midline of the base of the tongue. All tumors were large T3 or T4 lesions ordinarily considered inoperable, and all patients had previously been treated by radiotherapy or surgery. The procedure developed makes it possible to carry out an effective en bloc resection of carcinomas of the lateral pharyngeal wall, tonsillar fossa, soft palate, nasopharynx, and base of tongue, together with their lymphatic drainage, in a one-stage operation. No mandibular resection is necessary and primary closure is possible in most instances. The morbidity of the operation is negligible, and the cosmetic and functional results are extremely satisfactory.