Perioperative difficulties and early postoperative complications of transoral approach in mouth base surgery

The aim of this study was to discuss perioperative difficulties and temporary or permanent complications that can be seen at early postoperative period in cases undergoing transoral surgical approach for disorders of mouth base.

The study included 19 patients undergoing transoral surgical approach between September 2011 and January 2013 who were retrospectively evaluated. Exclusion criteria were patients with malign submandibular gland tumor or other suspected tumors at mouth base, those with a benign solid mass larger than 10 × 10 cm, and those who did not accept the transoral approach.

Mean age was 28.47 ± 17.89 years (range, 8-76 years) in 19 patients included (9 male and 10 female subjects). Of these, submandibular gland excision was performed in 9 cases, whereas thyroglossal duct cyst excision was performed in 3 (2 transfrenulum approach and 1 lateral lingual approach), lymphangioma excision in 1, diagnostic lymph node excision at the posterior of submandibular gland in 3 cases, and dermoid cyst excision (2 with midline and 1 with left submandibular localization) in 3 cases. Perioperative difficulties included dissection problems due to adhesion, partial adhesion between Wharton canal and lingual nerve, fragmented dissection of the gland, capsule rupture of submandibular adenoma, and facial artery rupture. While visualization of surgical field and retraction of mouth base muscles are an important issue in midline approaches, resection of hyoid bone corpus is challenging in lateral approaches. Early postoperative complications included edema at mouth base, lingual ecchymosis, and postoperative temporary abnormal tongue sensation.

Transoral mouth base surgery is a safe approach in selected patients. Permanent injuries of neural structures are rarely encountered, which is considered as a concern by head and neck surgeons. Temporary complications are at a level that can be tolerated by patients.