Transoral Robotic Resection of Pediatric Tongue Base Mucoepidermoid Carcinoma

Mucoepidermoid carcinoma (MEC) of the base of the tongue is exceedingly rare in the pediatric population. While transoral robotic surgery (TORS) has expanded minimally invasive options for oropharyngeal malignancies in adults, its application in pediatric tongue base tumors remains limited. This report aims to highlight the feasibility and oncologic adequacy of TORS in a carefully selected pediatric patient.

We report the case of a 13-year-old girl with low-grade MEC of the base of the tongue treated with TORS using the da Vinci Xi surgical system (Intuitive Surgical Inc.). Surgical duration, intraoperative findings, histopathologic features, and postoperative course were analyzed. Relevant literature regarding pediatric applications of TORS and alternative surgical approaches was reviewed.

Complete en bloc resection with negative margins (R0) was achieved in 37 min without measurable blood loss. A branch of the right lingual artery was safely clipped under robotic visualization. The postoperative course was uneventful, and nasogastric feeding was maintained until postoperative Day 7. Histopathologic analysis confirmed low-grade MEC with negative margins and demonstrated MAML2 rearrangement in more than 50% of tumor cells by fluorescence in situ hybridization. No adjuvant therapy was indicated.

Transoral robotic surgery may represent a safe, minimally invasive, and oncologically appropriate surgical option for carefully selected pediatric patients with tongue base mucoepidermoid carcinoma. Further multicenter studies are warranted to better define long-term oncologic and functional outcomes in this population.

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