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Access to the craniovertebral junction has traditionally been obtained by utilizing transoral approaches; however, the nasal corridor is a useful alternative for direct access to the craniovertebral junction with decreased morbidity. The inferior extent of the endonasal approach is limited by the palate and nasal bones and when this is reached, the caudal extent can be expanded with the combined endonasal-transoral approach. The addition of the transoral corridor allows more caudal access and allows for more complex reconstructions. In this chapter, we discuss a step-wise approach to planning for surgical access of the craniovertebral junction.
Combined skull base approaches have become increasingly popular to address intracranial and head and neck lesions. Improved endoscopic visualization, endoscopic tools, and surgical techniques have allowed safer and more ready access to difficult regions in the skull base. Historically, the parapharyngeal space and infratemporal fossa have been considered distinct locations in the head and neck that have been a challenge to access. This chapter details endoscopic endonasal, transoral, and transcervical approaches, along with a review of general indications, utility, and microsurgical anatomy.
The global coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid alterations to diagnostic pathways for head and neck cancer patients that aim to reduce risk to patients (exposure to the hospital environment) and staff (aerosol-generating procedures). Transoral fine needle aspiration cytology offers a low-risk means of rapidly diagnosing patients with oral cavity or oropharyngeal lesions. The technique was utilised in selected patients at our institution during the pandemic. The outcomes are considered in this study.
Method
Diagnostic outcomes were retrospectively evaluated for a series of patients undergoing transoral fine needle aspiration cytology of oral cavity and oropharyngeal lesions during the COVID-19 pandemic.
Results
Five patients underwent transoral fine needle aspiration cytology, yielding lesional material in 100 per cent, with cell blocks providing additional information. In one case, excision biopsy of a lymphoproliferative lesion was required for final diagnosis.
Conclusion
Transoral fine needle aspiration cytology can provide rapid diagnosis in patients with oral cavity and oropharyngeal lesions. Whilst limitations exist (including tolerability and lesion location), the technique offers significant advantages pertinent to the COVID-19 era, and could be employed in the future to obviate diagnostic surgery in selected patients.
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