In a recent post we discussed the anatomy and nuanced strategies for managing the lingual artery in TORS. Let us now examine a pertinent case study.
A young otherwise healthy individual underwent TORS for a T2 HPV+ squamous cell carcinoma of the base of the tongue. Preoperative CT scan indicated the feasibility of achieving clear margins while also highlighting the proximity of the main trunk of the lingual artery.
True to expectation, due to the extension of the tumour resection the lingual artery was distinctly exposed during the procedure.
As the surgical defect is not to be covered but left for secondary healing, there is a risk of lingual artery rupture in the postoperative period. Such an event, involving a high-pressure artery, direct branch of the external carotid artery, could precipitate a critical emergency. Bleeding from the lingual artery in this scenario would likely lead to the patient being asphyxiated by blood flow directly above the larynx.
Consequently, the recommendation is that, when the lingual artery is exposed, it should be clipped. See how it is done.
Moreover, for added safety in this case, following the completion of the right functional neck dissection, the lingual artery was identified and ligated after its separation from the external carotid artery. This strategic intervention ensures that the artery is devoid of direct blood flow, significantly minimizing the likelihood of postoperative bleeding.
