편도 편평세포암의 수술적 치료

Abstract

The records of 24 patients with squamous cell carcinoma of the tonsillar fossa treated surgically from January 1992 through August 1994 were reviewed. Surgical approaches, local and regional findings and surgical techniques were evaluated. Patients were treated by surgery alone(5 patients), by surgical salvage in salvage in radiation failure cases (3 patients), surgery combined with radiation(16 patients). T1, T2 were 13 cases and T3, T4 advanced cases were II. All ipsilateral necks were treated surgically with resection of primary. Pathologically proven cervical metastases were 83.3%(20/24). This data shows extremely high cervical metastatic rate in tonsillar carcinoma even its primary site is small in size. So more precisse evaluation and more aggressive approach of the neck are needed. Only three primary could be excised transoral route, and majorities needed transmadibular approach. Mandibular swing provides wide and adequate field. Partial mandibulectomy which resects the lingual cortex in high risk of invasion provides more wide excision of the primary and sound postoperative function and esthetic figure. Tonsillar defects were closed primarily in 13 patients, and 10 patients by pectoralis major myocutaneous flap, one were reconstructed with forearm free flap. The one year determinate survival was 87%. One died perioperatively, two died of disease, the other one died of intercurrent disease and 20 patients are alive without disease.