Transoral laser microsurgery for the unknown primary: role for lingual tonsillectomy

Head Neck. 2014 Jul;36(7):942-6. doi: 10.1002/hed.23372. Epub 2014 May 19.


Background: We conducted a retrospective review of patients with unknown primary head and neck cancer who underwent a transoral laser microsurgery (TLM)-assisted search for an occult tumor.

Methods: Fifty-two patients at a single center with unknown primaries of squamous cell carcinoma (SCC) were treated with a surgical algorithm.

Results: The overall rate of primary tumor identification was 75% (39 of 52 patients). When selecting those cases in which a TLM algorithm with lingual tonsillectomy was utilized, the detection rate was 86% (31 of 36). Tumors were most commonly found in the lingual (65.0%) and palatine tonsils (27.5%). When directed biopsies did not locate a tumor, a higher yield was obtained with the addition of a lingual tonsillectomy in 8 patients.

Conclusion: A surgical algorithm for the unknown primary that includes TLM-assisted techniques, including a lingual tonsillectomy, offers the greatest likelihood of successfully detecting the location of occult primary tumors.

Keywords: TLM; carbon dioxide laser; human papillomavirus; transoral; unknown primary.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / secondary
  • Carcinoma, Squamous Cell / surgery*
  • Carcinoma, Squamous Cell / virology
  • Female
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / surgery*
  • Head and Neck Neoplasms / virology
  • Human papillomavirus 16 / isolation & purification
  • Humans
  • Immunohistochemistry
  • Laryngoscopy
  • Laser Therapy*
  • Lymphatic Metastasis
  • Male
  • Microsurgery*
  • Middle Aged
  • Neoplasms, Unknown Primary / surgery*
  • Retrospective Studies
  • Tonsillectomy*