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Laser tongue base mucosectomy is a useful diagnostic tool in the management of unknown primary cancers of the head and neck region

Published online by Cambridge University Press:  08 June 2022

O Olaleye Open the ORCID record for O Olaleye [Opens in a new window] ,
R Nassif ,
B Fleming  and
S Burrows
O Olaleye*
Affiliation:
ENT & Audiology, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK
R Nassif
Affiliation:
ENT & Audiology, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK
B Fleming
Affiliation:
Anaesthesia, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK
S Burrows
Affiliation:
ENT & Audiology, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK
*
Author for correspondence: Dr O Olaleye, ENT & Audiology, Norfolk & Norwich University Hospitals NHS Trust, Colney Lane, Norwich, NR4 7UY, UK E-mail: dejolaleye@yahoo.com Fax: +44 1603 287288
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Abstract

Objective

Tongue base mucosectomy identified cancer in 78 per cent of cancers of unknown primary in a recent meta-analysis. The carbon dioxide laser is an alternative technique if there is no access to a robot. This study aimed to describe the steps for undertaking tongue base mucosectomy using the carbon dioxide laser and its diagnostic utility in cancers of unknown primary.

Method

This was a prospective feasibility study utilising carbon dioxide laser for tongue base mucosectomy in cancers of unknown primary. Data collected included demographic data and p16 status.

Results

There were 14 cancers of unknown primary with 86 per cent p16 positivity on immunohistochemistry. Laser tongue base mucosectomy alone identified the cancer primary in 7 of 12 (58 per cent) cancers of unknown primary among p16 positive tumours and 0 of 2 (0 per cent) among p16 negative tumours. Combining bilateral tonsillectomy with laser tongue base mucosectomy resulted in identification of the primary cancer in 8 of 12 (67 per cent) p16 positive tumours.

Conclusion

In centres without a robot, tongue base mucosectomy using the carbon dioxide laser is a viable alternative, especially in combination with bilateral tonsillectomy in p16 positive cases.

Keywords

C02 LaserTongue BaseMucosectomyLingual TonsilUnknown PrimaryHead And Neck Cancer
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 4 , April 2023 , pp. 438 - 441
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr O Olaleye takes responsibility for the integrity of the content of the paper

References

Mackenzie, K, Watson, M, Jankowska, P, Bhide, S, Simo, R. Investigation and management of the unknown primary with metastatic neck disease: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130(suppl S2):170–5CrossRefGoogle ScholarPubMed
Strojan, P, Ferlito, A, Medina, JE, Woolgar, JA, Rinaldo, A, Robbins, KT et al. Contemporary management of lymph node metastases from an unknown primary to the neck: a review of diagnostic approaches. Head Neck 2013;35:123–32CrossRefGoogle Scholar
Farooq, S, Kanadavilli, S, Dretzke, J, Moore, D, Nankivell, P, Sharma, N et al. Transoral tongue base mucosectomy for the identification of the primary site in the work-up of cancers of unknown origin: systematic review and meta-analysis. Oral Oncol 2019;91:97–106CrossRefGoogle ScholarPubMed
Winter, SC, Ofo, E, Meikle, D, Silva, P, Fraser, L, O'Hara, J et al. Trans-oral robotic assisted tongue base mucosectomy for investigation of cancer of unknown primary in the head and neck region: the UK experience. Clin Otolaryngol 2017;42:1247–51CrossRefGoogle ScholarPubMed
Karni, RJ, Rich, JT, Sinha, P, Haughey, BH. Transoral laser microsurgery: a new approach for unknown primaries of the head and neck. Laryngoscope 2011;121:1194–201CrossRefGoogle ScholarPubMed
Graboyes, EM, Sinha, P, Thorstad, WL, Rich, JT, Haughey, BH. Management of human papillomavirus-related unknown primaries of the head and neck with a transoral surgical approach. Head Neck 2015;37:1603–11CrossRefGoogle ScholarPubMed
Nagel, TH, Hinni, ML, Hayden, RE, Lott, DG. Transoral laser microsurgery for the unknown primary: role for lingual tonsillectomy. Head Neck 2014;36:942–6CrossRefGoogle ScholarPubMed
Durmus, K, Patwa, HS, Gokozan, HN, Kucur, C, Teknos, TN, Agrawal, A et al. Functional and quality-of-life outcomes of transoral robotic surgery for carcinoma of unknown primary. Laryngoscope 2014;124:2089–95CrossRefGoogle ScholarPubMed
Mehta, V, Johnson, P, Tassler, A, Kim, S, Ferris, RL, Nance, M et al. A new paradigm for the diagnosis and management of unknown primary tumors of the head and neck: a role for transoral robotic surgery. Laryngoscope 2013;123:146–51CrossRefGoogle ScholarPubMed