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Tongue base mucosectomy for carcinoma of unknown primary using endoscopic electrocautery: rationale for wider implementation of an institutionally restricted technique

Published online by Cambridge University Press:  20 November 2018

C R Davies-Husband*
Affiliation:
Department of ENT, Head and Neck Surgery, Royal Sussex County Hospital, Brighton, and Head and Neck Unit, Queen Victoria Hospital, East Grinstead, UK
*
Author for correspondence: Dr C R Davies-Husband, Head and Neck Unit, Queen Victoria Hospital, Holtye Rd, East Grinstead RH19 3DZ, UK E-mail: camerondh@doctors.org.uk

Abstract

Background

Cervical metastasis from an unknown primary site invariably results in pan-mucosal irradiation if a primary tumour is not identified. Transoral robotic and laser-assisted mucosectomy are valid techniques to increase diagnostic rates, but these remain restricted to certain centres. This paper describes, in detail, a technique in which mucosectomy is performed via endoscopic electrocautery.

Methods

Patients were prospectively recruited between May 2017 and June 2018. Inclusion criteria stipulated biopsy-proven metastatic cervical squamous cell carcinoma, with negative findings on magnetic resonance imaging and positron emission tomography/computed tomography, in addition to examination under anaesthetic, tonsillectomy and ‘blind’ tongue base biopsies without tumour identification, prior to mucosectomy.

Results

Of nine patients, a mucosal primary was identified in four (44.4 per cent), for which ipsilateral intensity-modulated radiotherapy was advocated in three and completion tongue base resection in the fourth. Dysplasia was demonstrated in two further patients, which provided information relevant to radiotherapy fields and post-treatment surveillance. No surgical complications were identified.

Conclusion

Tongue base mucosectomy using electrocautery and conventional tonsillectomy equipment is a safe, effective technique in the identification of cervical metastasis from an unknown primary site. It expands the potential breadth of use, quickens prolonged diagnostic pathways and obviates the necessity for pan-mucosal irradiation.

Type
Short Communications
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr C R Davies-Husband takes responsibility for the integrity of the content of the paper

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