1.1 (a) Transoral view of the oropharynx. The tonsillar bed is bounded laterally by the superior pharyngeal constrictor muscle, superiorly by the soft palate, and inferiorly by the base of the tongue. The anterior and posterior tonsillar pillars create the anterior and posterior boundaries of the tonsillar bed. These structures are created by the mucosa overlying the palatoglossus and palatopharyngeus muscles, respectively. The mucosal landmarks of the anterior and posterior tonsillar pillars should initially be identified. The uvula should be seen at the bottom of the visual field with the tongue base at the superior aspect of the visual field. 1.1ashows the overview of the oropharynx from the viewpoint of the surgical robot endoscope. The robotic view will display the oral cavity in a vantage point familiar to otolaryngologists. The TORS radical tonsillectomy starts with proper exposure. With the exception of the mesial free surface, the tonsil is surrounded by a distinct fibrous capsule, and external to this capsule is found the pharyngeal aponeurosis. The boundaries of the palatine tonsils are as follows:Īnterior fibers of palatopharyngeus muscle 2Other non–tumor-related contraindications include trismus that prevents adequate exposure, a retropharyngeal internal carotid artery, and any medical comorbidities precluding the patient from general anesthesia or surgery. 2Contraindications for TORS radical tonsillectomy include stage IVC cancer (with exception for curable, solitary, distant metastasis), T4a cancer (with exception of those involving only the extrinsic muscles of the tongue or minimal involvement of the medial pterygoid muscle), radiologic evidence of tumor adjacent to the common or internal carotid artery, any T-stage tumor with fixed invasion of tissues lateral to the pharyngeal constrictor muscles or posteriorly of the prevertebral fascia, unresectable node involvement, and dermal metastasis. The main indication for TORS is primary resection of squamous cell carcinoma of the tonsillar fossa, specifically T1 and T2 tumors with selected T3 and T4a neoplasms. The indications for TORS radical tonsillectomy are well described in the literature, though as surgeons gain more experience, some of what formerly were absolute contraindications are now becoming relative contraindications.
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