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Dental implications of transoral robotic surgery (TORS) in the management of head and neck cancer Shir Lynn Tan Laura Warner Jenna Trainor Dental Update 2024 49:6, 707-709.
Authors
Shir LynnTan
BDS, BSc (Hons), MFDS RCPS (Glasg)
DCT2 Oral and Maxillofacial Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust
Transoral robotic surgery (TORS) is increasingly being used in the UK as an alternative to other treatment modalities for the management of head and neck cancer. This article describes key features of the robotic system, and discusses risks of peri-operative dental complications that can arise as a result of introducing large robotic instruments into the confined space of the oral cavity. It also explores potential solutions and the role of dentists in reducing the risks of inadvertent hard and soft tissue injuries occurring during the procedure.
CPD/Clinical Relevance: A basic understanding of current surgical treatment modalities and their dental implications is important for GDPs.
Article
Surgery is a key treatment modality in the management of head and neck cancer. Over the past few decades, new surgical strategies and techniques have been developed in efforts to improve oncological and functional outcomes. Conventional open resection procedures typically involve transmandibular and transpharyngeal surgical approaches, with free flap reconstructions. These approaches cause significant functional impairment, with prolonged periods of rehabilitation post-operatively and long-term sequelae, such as dysphagia, dental misalignment, and higher rates of osteoradionecrosis of the mandible following adjuvant treatment.1,2 In 1970s, the development of transoral laser microsurgery (TLM) laid the groundwork for more minimally invasive head and neck procedures. In TLM, tumours are visualized through an endoscope and resected by the surgeon using carbon dioxide lasers through the oral cavity. This greatly reduced surgical morbidity and allowed selective ablation of a tumour. However, several challenges were encountered with this technique. Limited angulation of instruments resulted in restricted visualization and access to areas of the oropharynx, larynx and hypopharynx. The effect of natural surgeon tremor magnified along the shaft of the instrument occasionally led to surgical imprecision.3
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