Transoral videolaryngoscopic surgery with a navigation system for excision of a metastatic retropharyngeal lymph node

To report the utilization of a new transoral surgery system, i.e. transoral videolaryngoscopic surgery (TOVS) with a navigation system, for the removal of a metastatic retropharyngeal lymph node (RPLN).

An 86-year-old woman with tongue cancer (cT2N0M0) underwent partial glossectomy and left selective neck dissection. Three months postoperatively, a left metastatic RPLN was identified on follow-up magnetic resonance imaging. The metastatic RPLN was successfully excised by TOVS with a navigation system. After postoperative irradiation, she had no recurrence more than 1 year after the surgery.

The retropharyngeal space (RPS) is a difficult area to access surgically. A transcervical approach is conventionally used to access the RPS; however, in the present case, scar tissue after neck dissection may have been problematic. Visualization of the RPS by high-definition endoscopy and a navigation system were effective in facilitating the safe performance of the surgery.

A transoral approach may be a viable choice for surgery of a metastatic RPLN. Surgical indications for a transoral approach to the RPS include that (1) the location of the RPLN is below the level of the hard palate and the pterygoid hamulus and (2) there is only a single lesion, without adhesion to the surrounding tissue.