The Trotter procedure: a forgotten approach?
A 42-year-old male with Gorlin syndrome was referred by his General Practitioner to the Ear, Nose and Throat department with progressive dysphagia and voice change. Examination including fibre-optic nasendoscopy was normal, whilst magnetic resonance imaging (MRI) of the tongue base revealed no pathology. Following a period of observation, his symptoms progressed and a repeat MRI showed a discrete mass in the tongue base (Fig. ). A panendoscopy was performed and biopsies demonstrated a myolipoma.\nAs the diagnosis was benign, the head and neck multidisciplinary team recommended laser de-bulking, and this was subsequently carried out on two separate occasions. The patient's dysphagia, however, became progressively worse, and it was therefore decided to resect the tumour via a median labiomandibular glossotomy (Trotter procedure) for access.\nFollowing a prophylactic tracheostomy, access to the tongue base lesion was achieved by successive midline divisions of the lip, mandible, floor of mouth and tongue (Fig. ). The tongue was divided avascularly along its midline raphe.\nThe tumour was successfully removed and the tongue and floor of mouth closed in layers. The mandible was reduced and fixed using pre-bent 2.0 miniplates and screws, before placement of a suction drain and closure of the lip.\nThe patient underwent an uneventful recovery. The tracheostomy was removed on the third post-operative day and a soft diet was re-established by the fifth day. The patient was discharged 7 days after the procedure. At 3-month follow-up, he reported no functional impairment and the surgical site had healed well (Fig. ). Too date, 3 years post-operatively, he remains asymptomatic with no evidence of tumour recurrence.