![]() ![]() The nerve crosses deep to the submandibular duct in the lateral FOM in the anterior FOM it is located posterior to the duct ( Figures 7, 8). The lingual nerve is a branch of V3 and provides sensory innervation to the floor of the mouth (FOM). The only notable nerves encountered at surgery are the lingual, inferior alveolar and mental nerves, and possibly the XIIn if resection includes the lateral tongue.įigure 7: V3, lingual, inferior alveolar and mental nervesįigure 8: V3, lingual, inferior alveolar and mental nerves The buccopharyngeal fascia constitutes the s erosal layer it is the outermost coat of the pharynx and is a thin layer of connective tissue that forms the anterior wall of the prevertebral space. The tonsils are situated between the anterior and posterior pillars, with the pharyngeal constrictor muscle lateral to the tonsil. The palatopharyngeus muscles constitute the posterior faucial/tonsillar pillars. The anterior faucial/tonsillar pillars are formed by the palatoglossus muscles with a thin mucosal covering and constitute the anterior limit of the oropharynx, behind which it is encircled by the superior and middle constrictor muscles ( Figures 2, 4, 5, 6). Posteriorly it forms a median raphe to which the pharyngeal constrictors attach ( Figure 5). It fills the gaps between the skull base and the superior constrictor, the superior and middle constrictors, and the middle and inferior constrictors ( Figure 5). The submucosa is represented by the pharyngobasilar fascia it thins as it extends inferiorly from its attachment to the skull base and lines the inner aspect of the constrictor muscles. Readers are referred to other chapters in the Open Access Atlas of Otolaryngology, Head & Neck Operative Surgery for detailed descriptions of Transoral laser microsurgery (TLM), Transoral lateral oropharyngectomy/radical tonsillectomy, and Resection of cancers of the base of tongue.įigure 3: Lateral view of soft palate and its attachment to the hard palateįigure 4: Posterior view of the soft palate and pharynx with the superior constrictor splayed openįigure 5: Posterior view of the pharynx illustrates the attachment of the superior constrictor to the pharyngobasilar fascia above and the median raphe to which the pharyngeal constrictors attach note the close anatomical relationships of the internal and external carotid artery systems to the pharynxįigure 6: Note how buccinator and superior constrictor muscles attach to the pterygomandibular raphe transoral excision using electrocautery, CO 2 laser or robotics vs. This chapter describes transoral and transmandibular resection of cancer of the oropharynx it does not address the debate of the relative merits of chemoradiation vs. Management of cancer of the oropharynx has undergone a paradigm shift in recent years following the realization that HPV infection is both an etiologic and prognostic factor for a subset of oropharyngeal squamous cell carcinoma the introduction of transoral robotic surgery (TORS) to resect oropharyngeal tumors as well as attempts to reduce the morbidity of chemoradiation by accepting smaller resection margins when combined with postoperative irradiation. ![]()
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