Transoral laser microsurgery for the unknown primary: Role for lingual tonsillectomy

Thomas H. Nagel, Michael L. Hinni, Richard E. Hayden, David G. Lott

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)942-946
Number of pages5
JournalHead and Neck
Issue number7
StatePublished - Jul 2014


  • TLM
  • carbon dioxide laser
  • human papillomavirus
  • transoral
  • unknown primary

ASJC Scopus subject areas

  • Otorhinolaryngology


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