Evolution of robotic systems for transoral head and neck surgery.

Oropharyngeal tumor is traditionally resected from an open approach, often necessitating the need of a midline mandibulotomy in order to remove tumor safely with oncologic margins. The limitations imposed by a transoral route include poor visualization of the inferior extent of the oropharynx, rigid instrumentation, and inability to resect tumor that extends caudally into the supraglottis. While visualization with angled endoscopes, coupled with flexible laser development and microscopic magnification may overcome some of these limitations, this technique suffers from linear trajectory of the instruments which hampers expedient surgical resection in a 3-dimensional fashion. With development of the Da Vinci Surgical System, the safety and oncologic feasibility of removing oropharyngeal tumors are made possible because it provides a 3-dimensional magnification of the surgical field and wristed maneuverability of the surgical instruments which enable surgeons to operate around tight anatomical confines. Nevertheless, this first-generation robot is continually being modified with more flexibility and maneuverability through the development of robots like the FLEX Robotic System and more recently the Da Vinci Single Port System (SP). In this review, we will discuss the historic developments of robots for transoral applications, present the current approved robotic systems, and highlight the upcoming robots for transoral robotic surgery (TORS). Finally, we will also propose an ideal TORS surgical robot by highlighting the engineering technologies to accomplish these challenges.

[Parapharyngeal space--history and surgical study]. / Spatiul parafaringian--istoric si implicatii chirurgicale.

UNLABELLED: One area of anatomy, which is a true passage of secrecy, is the anatomy of the potential anatomical spaces. The study of the fascial layers of the head and neck and the potential spaces they make-up is both fascinating and confusing. Much of the confusion is a function of the multiple synonymous terms and classifications that various authors use, and not the basic anatomical description. Their anatomy and communications, to the base of skull and downward to diaphragm, acts like a route through which infection from mouth and throat can reach the superior mediastinum. CONCLUSIONS: Understanding the anatomy of the parapharyngeal space is important in making a correct diagnosis and surgical plan for removing tumors in this region.

[The hypertrophy of pharyngeal tonsill in the estimation of XIX-century physicians]. / Przerost migdalka gardlowego w ocenie XIX-wiecznych lekarzy.

The role of such physicians as Rudolph A. Kolliker, Johann N. Czermak, Ludwig Tuerck, Friedrich E. Voltlini, Benjamin B. Loewenberg, Hubert v. Luschka in the building of the science on hypertrophy of pharyngeal tonsil are pointed out first of all. The specific significance of achievements of Wilhelm Meyer (1824-1895) of Copenhagen based on scrupulous examinations is described. In the Polish territories the innovatory were works of Teodor Heryng, Klemens Koehler, Wladyslaw Wróblewski, Jan Sedziak, Teofil Zalewski. The epidemiology, etiology, pathogenesis, anatomo-patological examinations, the role of pharyngeal tonsil on immunity system are presented widely. The influence of hypertrophy of pharyngeal tonsil on general evolution of child, on his intellectual sphere, on speech disorders, on upper respiratory tract disorders, on auditory disorders, on the origination of deaf-mutism, on the origination of reflexogenous neuroses are described in more detail. An important role of anterior rhinoscopy, posterior rhinoscopy, and digital examination in the diagnosis of this illnes are also presented with full particulars.