Nagel, Thomas H.

BackgroundWe 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.MethodsFifty‐two patients at a single center with unknown primaries of squamous cell carcinoma (SCC) were treated with a surgical algorithm.ResultsThe 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.ConclusionA 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. © 2014 Wiley Periodicals, Inc. Head Neck 36: 942–946, 2014