Case Report

Transoral Robotic Surgery: Step-by-Step Radical Tonsillectomy

Figure 3

Stylopharyngeus cut sequence (from left, clockwise). The quadrangular shape represents the superior constrictor muscle and the triangular one the stylopharyngeus, right side. The aim is to completely cut the stylopharyngeus about 1 cm lateral to the constrictor. First the Bowie is inserted dissecting between the prevertebral fascia and the stylopharyngeus muscle, parallel to the constrictor. With the tip of the Bowie resting on the fascia, the wrist of the instrument is turned upwards. This creates a space under the muscle. The Maryland is crossed under the Bowie to grasp the muscle with the jaws parallel to the constrictor. Finally, the Bowie is used to cut the muscle just lateral to the Maryland. The sequence can be repeated as many times as necessary to completely split the stylopharyngeus.
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