Transoral Surgical Anatomy and Clinical Considerations of Lateral Oropharyngeal Wall, Parapharyngeal Space, and Tongue Base

Objective With the emergence of transoral robotic approaches, head and neck surgeons are faced with an unfamiliar inside-out head and neck anatomy. This study was performed to describe key anatomic landmarks and surgical considerations of transoral robotic resection of the lateral oropharyngeal wall, the parapharyngeal space, and the base of the tongue. Study Design Descriptive transoral anatomic study. Setting Academic anatomy laboratory and tertiary academic hospital. Subjects and Methods Transoral dissections of the lateral pharyngeal wall, base of tongue, and parapharyngeal space were performed in 5 vascular silicone-injected cadavers to illustrate anatomic landmarks from the inside-out perspective. Lateral neck dissections were also performed to better appreciate the anatomic structures and to be more familiar with intraoperative anatomy. Results The neurovascular and muscular structures located in parapharyngeal space, lateral oropharyngeal wall, and base of tongue were described. Surgical significance of key anatomic landmarks was emphasized with high-quality illustrations. Conclusion A thorough understanding of transoral anatomy is crucial to perform transoral robotic surgery safely and efficiently. To understand inside-out anatomy of base of tongue, lateral oropharyngeal wall, and parapharyngeal space, cadaveric dissection is highly beneficial and may help to shorten the learning curve for transoral robotic dissections.