How I do it: transpharyngeal resection of base of tongue cancer with hyoid suspension

Abstract Objective Transoral robotic surgery is increasingly used for selected base-of-tongue tumours, but is often impractical in patients with severe trismus and remains cost prohibitive. Conventional transmandibular approaches are associated with significant morbidity. We describe a transpharyngeal technique incorporating hyoid suspension to address these limitations. Methods A retrospective series of patients undergoing transpharyngeal resection for base-of-tongue carcinoma is presented. The technique includes neck dissection with vascular control, lateral-inferior pharyngotomy, tumour excision under direct visualisation and reconstruction with pectoralis major myocutaneous flap with routine hyoid suspension. Hypoglossal nerve preservation was undertaken where oncologically appropriate. Results Fifteen previously untreated patients were treated, including 12 with severe trismus. Clear margins were achieved in 13 cases. Reconstruction was performed with a pectoralis major myocutaneous flap in 13 patients. Most patients achieved decannulation and oral feeding within 30 days. Conclusion Transpharyngeal resection with hyoid suspension is a feasible and cost-effective alternative to transoral robotic surgery in selected base-of-tongue cancers, particularly in patients with severe trismus.