Oropharyngeal squamous cell carcinoma (OPSCC), commonly referred to as throat or tonsil cancer, is a type of head and neck malignancy arising from the base and posterior third of the tongue, tonsils, soft palate, and posterolateral pharyngeal walls. Standard treatment typically involves a single modality or a combination of surgery, radiotherapy, and/or chemotherapy. Despite favorable oncologic outcomes, chemoradiation is associated with considerable acute and long-term toxicities, including treatment-related mortality, debilitating dysphagia, fibrosis, severe xerostomia, and an increased risk of secondary malignancies. In this context, fluorescence-guided surgery (FGS) has emerged as a promising, minimally invasive intraoperative tool for OPSCC surgery. By leveraging indocyanine green (ICG), FGS offers enhanced visualization and real-time tissue differentiation, facilitating precise tumor resection and reducing the risk of surgical complications. This case presents an 83-year-old female patient who underwent radical OPSCC resection followed by complex reconstructive surgery utilizing a novel near-infrared FGS device.
The use of FGS via the IC-Flow 2 device allowed immediate assessment of perfusion dynamics during FFR, facilitating timely interventions such as revision of vascular anastomoses or the selection of alternative reconstructive strategies. Unlike conventional, subjective evaluation methods, ICG imaging provides improved metrics of tissue viability, which is critical in patients with compromised vascular status.
This case highlights the utility of advanced perfusion monitoring in oncologic surgery, particularly in OPSCC requiring microvascular reconstruction. The favorable outcome in a high-risk patient demonstrates the potential of ICG-fluorescence imaging to support intraoperative decision-making and enhance surgical safety. Further prospective studies with larger patient cohorts are needed to establish the efficacy, cost-effectiveness, and long-term safety of this approach. Standardized protocols and broader implementation, including in resource-limited settings, will be critical to optimizing its clinical adoption.
