Evolution of Transoral Surgery: Three Decades of Change in Patients, Pathologies, and Indications

Objective: To assess outcomes and complications of transoral and related surgeries for pathologies at the craniocervical junction.

Design: Combined prospective study and retrospective review.

Patients: Prospective study of 33 operations (DC, 2004–2011) and retrospective review of 496 operations (AC 1980–2004) in a total of 470 patients. Patient data included neurological status, co-morbidities, reason and type of surgery, complications, length of hospital stay, operation, and blood loss. Trends in surgery and factors associated with good and bad outcomes were assessed over this 30-year period.

Results: Of 528 operations, 318 simple transoral surgeries, 103 transoral surgeries with splitting of the palate, 58 “open-door” maxillotomies, and 8 mandibulotomies were performed. The frequency of operations peaked in the early 1990s, and has since declined steadily, mainly due to the decrease in the number of patients with severe rheumatoid arthritis. The incidence of craniocervical junction tumors remains constant.

The number of complications and length of stay in the high-dependency unit was significantly associated with the pre- and postoperative neurological status.

There was no significant difference in complication rates and length of stay between rheumatoid patients and those with tumors, infection, or trauma. However, there was a trend to more complications in patients with congenital basilar invagination, particularly osteogenesis imperfecta, although this was not statistically significant.

Conclusions: The number of transoral and associated operations has decreased over time. Transoral surgery is now mainly indicated for ventral midline tumors. Transnasal endoscopy shows promise and may be used as an alternative to transoral surgery in some cases.