During extensive transoral oncologic resections at the base of the tongue, encountering the lingual artery is almost inevitable. Therefore, preparation is crucial. Surgical tips.
While various anatomical references exist, the challenge lies in the fact that the soft tissue is movable, making fixed landmarks unreliable. Remember, the artery is typically found “down there in the lateral corner.” Additionally, you’ll need to penetrate the lingual muscle to locate it—it’s not something you’ll find during a standard lingual tonsillectomy.
Let’s revisit the anatomy. From a transoral perspective, the lingual artery forms a distinctive “loop.” A reliable reference point is the lateral end where the base of the tongue meets the vallecula, transitioning to the lateral wall. Additionally, being able to “feel” the hyoid bone can guide you. Dissect carefully and watch for the arterial pulse.
At the loop’s most protruding point, the dorsal lingual artery emerges. This artery supplies blood to your surgical specimen, so it must be clipped and cut.
The lingual artery will remain in the surgical field and will be covered by granulation tissue within a few days. However, if the artery itself is exposed, it’s advisable to collapse the blood flow (clip it without cutting). This precaution can help prevent potentially fatal bleeding during the postoperative period.
Transoral Robotic Surgery (TORS) offers exceptional visual control and surgical maneuverability, significantly enhancing your ability to manage complex situations. While other types of transoral endoscopic surgery can be used, they may not offer the same level of precision and success. What is usually an elegant surgical dissection with TORS can quickly become a surgical nightmare without optimal control.
Diagnosed with oropharyngeal cancer? Ask for TransOral Robotic Surgery.
J Granell. June 30, 2024