PDF(Pubmed)
Abstract：
With the rate of oropharyngeal cancer on the rise, appropriate surgical management is an increasingly important consideration. Much debate currently exists regarding the necessary extent of neck dissections when performing curative surgery for primary oropharyngeal malignancies. Here, we present the case of a 64-year-old patient with p16+ T1N1M0 squamous cell carcinoma (SCC) of the right tonsil. Approximately four years following transoral robotic surgery oropharyngectomy and ipsilateral level II-IV right selective neck dissection, metastatic SCC was discovered on fine-needle aspiration biopsy of a right perifacial lymph node (level Ib). The patient then underwent a revision right neck dissection at levels Ia and Ib. Adjuvant immunotherapy was recommended following revision neck dissection. Postoperative imaging and flexible laryngoscopy three months after surgery were not concerning for cervical lymphadenopathy or oropharyngeal lesions. Although rare, physicians must maintain a healthy level of suspicion for recurrence to level Ib in oropharyngeal primary malignancies.
摘要：
随着口咽癌发病率的上升，适当的手术管理是一个越来越重要的考虑因素.目前，在进行原发性口咽恶性肿瘤的根治性手术时，关于颈部淋巴结清扫的必要范围存在很多争论。这里,我们介绍了一例64岁的右扁桃体p16+T1N1M0鳞状细胞癌（SCC）患者。经口机器人手术口咽切除术和同侧II-IV级右选择性颈清扫术大约四年后，在右侧面周淋巴结(Ib级)的细针穿刺活检中发现转移性SCC.然后，患者在Ia和Ib水平接受了右颈淋巴结清扫术。建议在翻修颈清扫术后进行辅助免疫治疗。术后影像学和术后三个月的柔性喉镜检查不考虑颈部淋巴结肿大或口咽部病变。虽然罕见，对于口咽原发性恶性肿瘤的复发至Ib级,医师必须保持健康的怀疑水平.
