Transoral Laser Microsurgery a Viable Option for Head and Neck Patients

For example, with TLM physicians can map tumors and remove them without disturbing structures, nerves, and tissues because the procedure does not require making incisions through the neck as with open surgery, said Dr. Caruana. Instead, surgeons can take the tumor out through the mouth. In addition, TLM helps surgeons avoid tracheostomy, which is often needed to create a safe airway because of postoperative swelling associated when more traditional open surgical approaches, he explained.

TLM also lets physicians avoid disassembling the patient while clearing tumors, and results in fewer salivary leaks and fistulas as compared with open surgery, said Dr. Hinni.

John R. Salassa, MD

Moreover, patients undergoing TLM are able to swallow earlier than those who undergo open surgery and don’t have to wait for suture lines to mend, Dr. Hinni added.

Generally, hospital stays after TLM are two to three days, compared with a week to 10 days for open surgery, said Dr. Salassa.

TLM also helps physicians make decisions about postoperative therapy because the procedure requires meticulous frozen section analysis and careful evaluation of the entire tumor and neck disease, said Dr. Salassa. We have true pathologic staging and can more effectively prescribe adjuvant therapy, he said.

Because TLM can render a complete response in patients, if adjuvant therapy is indicated it may be possible to use lower doses of radiation or chemoradiation, said Dr. Salassa.

For treating first primary tumors, TLM is often a better option than radiation, said Dr. Caruana. If TLM is used for first primary cancers it can be used again for second primary tumors, whereas if radiation is used for first primary tumors, it cannot be used again, he explained. If you use TLM for the initial tumor, it leaves the option of further laser treatment as well as radiation treatment if the patient develops a second cancer or a tumor recurrence, he said.

Disadvantages

One drawback of TLM is that many patients will experience temporary minor aspiration, said Dr. Salassa. However, most people can tolerate this pretty well until healing takes place and they can swallow again, he said.

Another risk associated with the procedure is bleeding, which is rare but serious, said Dr. Salassa. It can be a real issue because with TLM we don’t close these wounds but leave them to heal by secondary intention, he said. If the patient does bleed and he or she is already aspirating, the situation can be life-threatening, he explained.