Innovative Robotic Access in Head and Neck Oncology: Trans-oral–Trans-buccal Approach for Salvage Oropharyngeal Tumors

Introduction Trans-oral robotic surgery has become a key minimally invasive modality for oropharyngeal malignancies, offering superior visualization, precision, and functional preservation compared with open techniques. Its feasibility, however, depends on adequate oral exposure. Severe post-radiation fibrosis or trismus frequently precludes conventional robotic docking, limiting its use in salvage settings. Technical modifications to access are therefore essential to extend robotic surgery to complex cases. Case Presentation We describe a 53-year-old man with previously treated carcinoma of the tongue followed by re-irradiation for nodal recurrence, who later developed a second primary tumor of the right tonsil. Because of absolute trismus from radiation-induced fibrosis, standard trans-oral access was impossible. A hybrid trans-oral–trans-buccal robotic approach was designed, allowing proper instrument triangulation and complete tumor excision with clear margins and smooth postoperative recovery. Conclusion Hybrid trans-oral–trans-buccal robotic access can safely overcome extreme exposure limitations such as absolute trismus. This technique broadens the indications of robotic surgery in salvage oropharyngeal oncology while avoiding the morbidity of mandibulotomy based open procedures.