title: Extent of neck dissection after transoral robotic surgical resection of oropharyngeal squamous cell carcinoma: Report of a case and potential indications for inclusion of level I in a selective neck dissection.
abstract: BACKGROUND
  With new minimally invasive surgical techniques playing a role in the management of early oropharyngeal carcinomas, appropriate surgical management of the neck is an increasingly important consideration.
  
  
  METHODS
  We present a case of a 47-year-old patient with a clinical T2N1M0 squamous cell carcinoma (SCC) of the right tonsil with anterior extension toward the floor of the mouth from the right glossotonsillar sulcus. Imaging revealed a solitary necrotic lymph node in level IIA. The decision was made to proceed with a transoral robotic pharyngectomy and selective neck dissection of levels II to IV, followed by adjuvant radiotherapy.
  
  
  RESULTS
  A postoperative scan revealed progressive regional disease in the anterior aspect of level IB, and, as such, a completion neck dissection of level I was performed.
  
  
  CONCLUSIONS
  Special consideration must be given to level I, particularly in patients with glossotonsillar sulcus involvement and anterior extension toward the floor of the mouth.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Noel
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Foreman
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009333:Neck / Q000601:surgery*; D037981:Neck Dissection / Q000379:methods*; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: oropharyngeal malignancy; robot; selective neck dissection; transoral robotic surgery