Objective: To introduce a new method of dissecting tonsil cancer via combined transcervical parapharyngeal space and the transoral approach and investigate the clinical efficacy and functional outcomes of the patients. Methods: The clinical data of patients with locally advanced tonsillar and lateral oropharyngeal wall carcinomas who underwent combined submandibular parapharyngeal space combined with transoral approach surgery at the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital between January 2019 and December 2023 were retrospectively analyzed. Clinical parameters including postoperative pathology, surgical margins, survival outcomes, oropharyngeal functional status, and complications were evaluated. Results: A total of 46 cases aged (57.8±7.6) years were included, with 36 males and 10 females. Concurrent oropharyngeal defect reconstruction was performed in 38 cases. Mandible splitting was avoided in all patients to ensure complete tumor resection with safety margins. Histopathological examination confirmed squamous cell carcinoma in all cases, with 34 (73.9%) human papilloma virus (HPV)-positive cases. Negative surgical margins were achieved intraoperatively in all patients. Five patients developed perioperative complications (pharyngeal fistula and postoperative hemorrhage), which were resolved through conservative management. Regular follow-up ranged from 6 to 61 months. Tracheostomy decannulation achieved at (18.2±5.7) days postoperatively. No significant voice or swallowing dysfunction was observed at 6 months postoperatively. Local recurrence occurred in three patients, which was stable after salvage surgery or chemotherapy. One patient died from unrelated malignancy, and 42 patients were free of recurrence and death. The 3-year progression-free survival rate was 92.9%, and the 3-year overall survival rate was 100%. Conclusion: The combined submandibular parapharyngeal space and the transoral approach demonstrates high safety profile and feasibility for selected locally advanced tonsillar carcinomas, with the advantages of minimal invasiveness, favorable functional preservation, and rapid postoperative recovery.
