Transoral Robotic Parapharyngeal Approach to the Submandibular Space

The aim of the study was to demonstrate a novel transoral parapharyngeal approach to the submandibular space. The method used was the clinical case of a patient presenting with an anteriorly based tumor in the left submandibular space. The video shows the transoral robotic technique for access to the submandibular space through the parapharyngeal space for removal of the tumor. This approach allows for high definition visibility and complete access to structures in the submandibular space including the submandibular gland. For robotic head and neck surgeons performing lateral oropharyngectomies, the anatomy is familiar, and the technique avoids potential access issues with traditional floor of mouth incisions. Furthermore, it provides a novel technique for identification of the hypoglossal nerve for potential preservation in oropharyngeal malignancy. The transoral robotic parapharyngeal approach to the submandibular space is safe, reproducible, and avoids unnecessary cervical incisions.