title: Transoral laser microsurgery for the unknown primary: role for lingual tonsillectomy.
abstract: BACKGROUND
  We conducted a retrospective review of patients with unknown primary head and neck cancer who underwent a transoral laser microsurgery (TLM)-assisted search for an occult tumor.
  
  
  METHODS
  Fifty-two patients at a single center with unknown primaries of squamous cell carcinoma (SCC) were treated with a surgical algorithm.
  
  
  RESULTS
  The overall rate of primary tumor identification was 75% (39 of 52 patients). When selecting those cases in which a TLM algorithm with lingual tonsillectomy was utilized, the detection rate was 86% (31 of 36). Tumors were most commonly found in the lingual (65.0%) and palatine tonsils (27.5%). When directed biopsies did not locate a tumor, a higher yield was obtained with the addition of a lingual tonsillectomy in 8 patients.
  
  
  CONCLUSIONS
  A surgical algorithm for the unknown primary that includes TLM-assisted techniques, including a lingual tonsillectomy, offers the greatest likelihood of successfully detecting the location of occult primary tumors.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Nagel
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hinni
authors.forename: Richard E
authors.initials: RE
authors.lastname: Hayden
authors.forename: David G
authors.initials: DG
authors.lastname: Lott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery* / Q000821:virology; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry; D007828:Laryngoscopy; D053685:Laser Therapy; D008207:Lymphatic Metastasis; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000601:surgery*; D012189:Retrospective Studies; D014068:Tonsillectomy
keywords: TLM; carbon dioxide laser; human papillomavirus; transoral; unknown primary