Classification system for lateral pharyngotomy: systematic study of anatomic exposure in a human cadaver model

Lateral pharyngotomy (LP) is a surgical procedure that allows exposure to tumors of the pharynx and supraglottic larynx. This study was undertaken to: (1) propose a classification system of LP used in exposing various sites of the oropharynx, supraglottis, and hypopharynx. (2) Describe the structures visible with each category of LP.

Five tissue-fixed human cadavers from our gross anatomy laboratory were dissected in a manner similar to surgical lateral pharyngotomy. After exposure of the neurovascular structures of the anterior compartment of the neck and laryngeal framework, traditional pharyngotomy was performed with entry between the hypoglossal nerve cephalically and the superior laryngeal nerve caudally (traditional LP). Progressively increased exposure was created by division of adjacent structures. The ability to visualize certain structures (epiglottis, ipsilateral and contralateral base of tongue, postcricoid area, arytenoids, uvula, soft palate, and vallecula) through the pharyngotomy was recorded.

The epiglottis and ipsilateral tongue base were visible via the traditional or Type I LP. Type II, III, and IV LP provided exposure to increasingly remote sites of the pharynx and supraglottic larynx. The additional exposure provided by each type of LP was consistent across all five cadaver specimens.

Our system catalogs the additional exposure of both cephalic and caudal tumor sites associated with division of adjacent structures. This anatomic study illustrates and systematizes the structures requiring division to provide access to a given tumor location.