Transoral laser microsurgery for the unknown primary: Role for lingual tonsillectomy

• Published in: Head & neck 2014-07, Vol.36 (7), p.942-946
• Main Authors: Nagel, Thomas H., Hinni, Michael L., Hayden, Richard E., Lott, David G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; carbon dioxide laser; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; Carcinoma, Squamous Cell - virology; Female; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Head and Neck Neoplasms - virology; human papillomavirus; Human papillomavirus 16 - isolation & purification; Humans; Immunohistochemistry; Laryngoscopy; Laser Therapy; Lymphatic Metastasis; Male; Microsurgery; Middle Aged; Neoplasms, Unknown Primary - surgery; Retrospective Studies; TLM; Tonsillectomy; transoral; unknown primary
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.23372

Background We conducted a retrospective review of patients with unknown primary head and neck cancer who underwent a transoral laser microsurgery (TLM)‐assisted search for an occult tumor. Methods Fifty‐two patients at a single center with unknown primaries of squamous cell carcinoma (SCC) were treated with a surgical algorithm. Results The overall rate of primary tumor identification was 75% (39 of 52 patients). When selecting those cases in which a TLM algorithm with lingual tonsillectomy was utilized, the detection rate was 86% (31 of 36). Tumors were most commonly found in the lingual (65.0%) and palatine tonsils (27.5%). When directed biopsies did not locate a tumor, a higher yield was obtained with the addition of a lingual tonsillectomy in 8 patients. Conclusion A surgical algorithm for the unknown primary that includes TLM‐assisted techniques, including a lingual tonsillectomy, offers the greatest likelihood of successfully detecting the location of occult primary tumors. © 2014 Wiley Periodicals, Inc. Head Neck 36: 942–946, 2014