Acta Scientific Medical Sciences (ASMS) (ISSN: 2582-0931)

Research Article Volume 5 Issue 6

Transoral Robotic Surgery and Oropharyngeal Tumors: Key Points in the Imaging Presurgical Workup

Antonello Vidiri MD1, Jacopo Zocchi MD2, Francesca Piludu MD1, Silvia Moretto MD2, Gerardo Petruzzi MD2, Julia Daffinà1, Marcello Greco MD1, Francesco Mazzola MD2, Barbara Pichi MD2, Valentina Manciocco MD2, Armando De Virgilio MD3,4 and Raul Pellini MD2

1Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
2Department of Otolaryngology & Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
3Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy
4Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano (MI), Italy

*Corresponding Author: Antonello Vidiri MD, IRCCS Regina Elena National Cancer Institute, Department of Radiology, via Chianesi 53, 00144 Rome, Italy E-mail:

Received: April 26, 2021; Published: May 19, 2021


Background: A major comprehension of the morphologic and radiologic anatomy of this region pushed the evolution and diffusion of mini-invasive techniques for the treatment of oropharyngeal benign and malignant lesions in the last decade.

Methods: We propose a radiological checklist for a systematic evaluation of the oropharyngeal region, with a particular reference to oropharyngeal squamous cell carcinoma (OPSCC) and its patterns of diffusion.

Results: Palatine tonsil, base of the tongue, soft palate and posterior oropharyngeal wall anatomy are thoroughly described with particular attention to the structures that need to be evaluated before a transoral surgical approach is considered.

Conclusion: Detailed preoperative evaluation of oropharynx anatomy is essential prior to any transoral approach for neoplastic disease. Routine use of a checklist strengthens multidisciplinary collaboration, supports a mutual professional growth and facilitates the analysis of treatment functional and oncological outcomes.

Keywords: TORS; Oropharynx; MR


  1. Scholfield DW., et al. “Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Improving Function While Maintaining Oncologic Outcome”. Otolaryngology–Head and Neck Surgery 3 (2020): 267-268.
  2. De Virgilio A., et al. “Trans-oral robotic surgery in the management of parapharyngeal space tumors: A systematic review”. Oral Oncology 103 (2020): 104581.
  3. Lechien JR., et al. “Surgical, clinical and functional outcomes of transoral robotic surgery for supraglottic laryngeal cancers: A systematic review”. Oral Oncology 109 (2020):
  4. de Almeida JR., et al. “Oncologic Outcomes After Transoral Robotic Surgery: A Multi-institutional Study”. JAMA Otolaryngology – Head and Neck Surgery12 (2015): 1043-1051.
  5. Dabas S., et al. “Oncological outcome following de-intensification of treatment for stage I and II HPV negative oropharyngeal cancers with transoral robotic surgery (TORS): A prospective trial”. Oral Oncology 69 (2017): 80-83.
  6. Di Maio P., et al. “Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta-analysis”. Head and Neck4 (2019): 1112-1121.
  7. Patel SA., et al. “Robotic surgery for primary head and neck squamous cell carcinoma of unknown site”. JAMA Otolaryngology – Head and Neck Surgery11 (2013): 1203-1211.
  8. Petruzzi G., et al. “Transoral Robotic Surgery in the Management of a Tongue Base Schwannoma”. Journal of Craniofacial Surgery (2020).
  9. Petruzzi G., et al. “Transoral robotic retropharyngeal lymph node dissection in a recurrent head and neck carcinoma”. Head and Neck11 (2019): 4051-4053.
  10. Tirelli G., et al. “Tailored resections in oral and oropharyngeal cancer using narrow band imaging”. American Journal of Otolaryngology2 (2018): 197-203.
  11. De Virgilio A., et al. “Anatomical-based classification for transoral lateral oropharyngectomy”. Oral Oncology 99 (2019): 104450.
  12. Trotta BM., et al. “Oral cavity and oropharyngeal squamous cell cancer: key imaging findings for staging and treatment planning”. Neurologic/Head and Neck Imaging 2 (2011): 339-354.
  13. Corey AS and Hudgins PA. “Radiographic imaging of human papillomavirus related carcinomas of the oropharynx”. Head and Neck Pathology 6 (2012): S25-40.
  14. Lenz M., et al. “Oropharynx, oral cavity, floor of the mouth: CT and MRI”. European Journal of Radiology3 (2010): 203-215.
  15. Zocchi J., et al. “The role of a post therapeutic surveillance program for sinonasal malignancies: Analysis of 417 patients”. Head and Neck (2019).
  16. Golusinski P., et al. “Evidence for the approach to the diagnostic evaluation of squamous cell carcinoma occult primary tumors of the head and neck”. Oral Oncology 88 (2019): 145-152.
  17. Wong WL., et al. “18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of occult primary head and neck cancers--an audit and review of published studies”. Clinical Oncology (R Coll Radiol). 24.3 (2012): 190-195.
  18. Gun R., et al. “Transoral Surgical Anatomy and Clinical Considerations of Lateral Oropharyngeal Wall, Parapharyngeal Space, and Tongue Base”. Otolaryngology–Head and Neck Surgery (2016).
  19. Kwan BYM., et al. “Transoral robotic surgery for head and neck malignancies: Imaging features in presurgical workup”. Head and Neck 11 (2019): 4018-4025.
  20. Gupta A., et al. “Imaging evaluation of the parapharyngeal space”. Otolaryngologic Clinics of North America 6 (2012): 1223-1232.
  21. Yousem DM., et al. “Carotid artery invasion by head and neck masses: prediction with MR imaging”. Radiology 3 (1995): 715-720.
  22. Regloix SB De and Maurin O. “Retropharyngeal course of the internal carotid artery”. (2017): 2017-2018.
  23. Gorphe P., et al. “Revisiting vascular contraindications for transoral robotic surgery for oropharyngeal cancer”. Laryngoscope Investigative Otolaryngology 2 (2018): 121-126.
  24. Baskin RM., et al. “Transoral robotic surgery for oropharyngeal cancer : patient selection and special considerations”. Cancer Management and Research 10 (2018): 839-846.
  25. Crecco M., et al. “Retromolar trigone tumors: evaluation by magnetic resonance imaging and correlation with pathological data”. European Journal of Radiology3 (1999): 182-188.
  26. Hsu WC., et al. “Accuracy of magnetic resonance imaging in predicting absence of fixation of head and neck cancer to the prevertebral space”. Head and Neck2 (2005): 95-100.
  27. Doumas S., et al. “Current thinking on the management of abnormal retropharyngeal nodes in patients with oral, oropharyngeal, and nasopharyngeal squamous cell carcinoma: a structured review”. British Journal of Oral and Maxillofacial Surgery 6 (2019): 515-528.
  28. Pellini R., et al. “Laryngeal vs oropharyngeal cancer: T2 or not T2”. Oral Oncology 109 (2020): 104678.
  29. Dallan I., et al. “Anatomical landmarks for transoral robotic tongue base surgery: comparison between endoscopic, external and radiological perspectives”. Surgical and Radiologic Anatomy 1 (2013): 3-10.
  30. Liu C., et al. “Ultrasonic Measurement of Lingual Artery and Its Application for Midline Glossectomy”. Annals of Otology, Rhinology and Laryngology (2020): 3489420913581.
  31. Bouhir S., et al. “Radiological assessment of mandibular invasion in squamous cell carcinoma of the oral cavity and oropharynx”. European Annals of Otorhinolaryngology, Head and Neck Diseases 5 (2019): 361-366.
  32. Corey A. “Pitfalls in the staging of cancer of the oropharyngeal squamous cell carcinoma”. Neuroimaging Clinics of North America 1 (2013): 47-66.
  33. Luginbuhl A., et al. “Preoperative cephalometric analysis to predict transoral robotic surgery exposure”. Journal of Robotic Surgery 4 (2014): 313-317.
  34. Arora A., et al. “Determination of biometric measures to evaluate patient suitability for transoral robotic surgery”. Head and Neck9 (2015): 1254-1260.
  35. Rich JT., et al. “Transoral laser microsurgery (TLM) +/- adjuvant therapy for advanced stage oropharyngeal cancer: outcomes and prognostic factors”. Laryngoscope 9 (2009): 1709-1719.
  36. Cohen MA., et al. “Transoral robotic surgery and human papillomavirus status: Oncologic results”. Head and Neck 4 (2011): 573-580.
  37. Iocca O., et al. “Lymph node yield and lymph node ratio in oral cavity and oropharyngeal carcinoma: Preliminary results from a prospective, multicenter, international cohort”. Oral Oncology 107 (2020).


Citation: Antonello Vidiri., et al. “Transoral Robotic Surgery and Oropharyngeal Tumors: Key Points in the Imaging Presurgical Workup". Acta Scientific Medical Sciences 5.6 (2021): 92-101.


Copyright: © 2021 Antonello Vidiri., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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