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Case report
Intraoral midline mandibulotomy to improve access for transoral robotic surgery (TORS) base of tongue resection in a retrognathic and microstomic patient
  1. Daniel Bestourous,
  2. Margaret Michel,
  3. Christopher Badger,
  4. Punam Thakkar and
  5. Arjun S Joshi
  1. Division of Otolaryngology—Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  1. Correspondence to Daniel Bestourous; bestourous{at}


A 74-year-old man was referred to a tertiary academic otolaryngology clinic for evaluation of a left-sided neck mass with unknown primary. Nuclear imaging modalities revealed a primary cancer located at the left tongue base. Further investigation revealed the tumour to be a p16 positive squamous cell cancer with metastatic spread to cervical lymph nodes of multiple levels. The patient was found on initial investigation to have microstomia and a retrognathic mandible, which are typically considered unsuitable for robotic surgery due to difficulties obtaining adequate exposure.

The patient underwent bilateral neck dissection, followed by transoral robotic-assisted left base of tongue resection. A midline intraoral mandibulotomy was performed to improve robotic access. Following tumour resection, the mandible was repaired using open reduction with internal plate fixation. Postoperative occlusion was maintained, and the patient recovered well from mandibulotomy with none of the morbidity or cosmetic defects associated with a traditional lip-split approach.

  • ear
  • nose and throat/otolaryngology
  • head and neck cancer
  • head and neck surgery
  • otolaryngology / ENT
  • surgical oncology

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  • Contributors ASJ, PT and CB conceived the study and oversaw the project. ASJ was the primary surgeon and PT performed the mandibulotomy. DB performed chart review of the patient with assistance from MM. DB interviewed the patient, and DB and MM wrote the manuscript with input from ASJ, PT and CB. ASJ, PT and CB provided critical revision of the manuscript. All authors reviewed the final manuscript before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.