Historically, the tongue base could only be safely accessed through complicated open surgical approaches through the neck. Delicate structures in the neck, such as the voice box, the trachea, the esophagus, lymph nodes, muscles, and large nerves make surgical resection difficult with significant complications including speech and swallowing impairment. Advances in transoral laser microsurgery have transformed the surgeon's ability to treat cancer that was not otherwise amenable to surgical therapy. The surgery is performed through the opening of the mouth using an endoscope with a lighted camera and microscopic lens to view the area. Using a CO-2 laser and micro-staging, surgeons carefully remove the tumor in small pieces minimizing disruption to nearby tissues, thereby reducing complications and the likelihood of infections. With a magnification of normal and abnormal tissue, the surgery is very precise which contributes to very good cancer outcomes. Transoral laser surgery is an acceptable and in many cases preferred option for managing appropriately sized tumors of the back of the tongue. Its overall safety and functional outcomes are in many cases superior to traditional open surgeries and potentially high-dose chemotherapy and radiation.
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