Surgical management of the base of tongue

Lesions of the base of tongue (BOT) present a considerable challenge to the head and neck surgeon. This area represents a 3-dimensional anatomic region that is integral to both speech and swallow functions in addition to forming an important part of the upper respiratory tract. Surgical access to this region is difficult, and is primarily dictated by the size and type of lesion involving the BOT. The head and neck surgeon must be adept in the full spectrum of surgical techniques available to access the BOT, while keeping in mind the associated impact of each procedure on both form and function. Such techniques include transoral procedures, suprahyoid pharyngotomy, lip-split mandibulotomy or mandibular swing, and pull-through procedures. This article describes these techniques and considers the advantages and disadvantages of each.