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Transoral robotic‐assisted microvascular reconstruction of the oropharynx

INTRODUCTION Transoral robotic surgery (TORS) enables head and neck surgeons to safely extirpate oropharyngeal tumors that were previously inaccessible without utility of traditional approaches involving a lip-split incision and mandibulotomy. The primary advantage of this approach compared to traditional open approaches is decreased morbidity for patients, with faster return of swallowing function, decreased blood loss, and improved cosmesis. For TORS resections of small oropharyngeal tumors, wounds are allowed to heal secondarily or closed primarily. This does not affect deglutition or speech function, as the defect size is relatively limited, and scar formation is limited. For larger resections of the base of tongue, lateral oropharyngeal wall, and soft palate, as well coverage over the carotid artery following transoral robotic resection soft tissue, reconstruction is essential. Free tissue transfer has been utilized successfully over the last 20 years for head and neck reconstruction of complex defects, such as oropharyngeal defects. The objective of this work is to describe the reconstruction of oropharyngeal defects utilizing transoral robotic surgery to inset free flaps, a relatively new technique. The primary advantages of this approach are avoidance of the standard lip-split, mandibulotomy approach, and improved functional results after large oropharyngeal resections utilizing TORS techniques.