although seldom undertaken , this approach still remains important for head and neck surgeons in accessing lesions of the tongue base , pharyngeal wall and cervical spine . we report the use of this technique to remove a rare benign mass from the tongue base . 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 .  1 ) . 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 . following 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 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 . the tracheostomy was removed on the third post - operative day and a soft diet was re - established by the fifth day . , 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 . first reported in 1991 , a myolipoma is a benign tumour of mature adipose and smooth muscles , most commonly seen in the abdomen . to our knowledge , myolipoma of the tongue base has only been reported in the literature on one occasion and this was also in association with gorlin syndrome . advise that caution must be applied if the lesion is situated in deep tissue as it may be confused with a well - differentiated liposarcoma . with this in mind , surgical resection must be considered and at the tongue base this can prove particularly challenging . the trotter procedure or median labio - mandibular glossotomy is an important technique to access and excise both benign and malignant tumours located in the tongue base , oropharynx and the cranio - cervical junction . when undertaking this approach , the surgeon should pay meticulous attention to remaining in the midline of the tongue , thereby utilizing its relatively avascular median plane and preserving the neurovascular bundles bilaterally .
anatomically , the surgical management of tongue base lesions is a challenging prospect for any head and neck surgeon . 
 william trotter described a median labio - mandibular glossotomy for access to such lesions ( meis jm , enzinger fm . 
 myolipoma of soft tissue . 
 am j surg pathol 1991;15:1215 ) . 
 not widely reported , this approach still remains an important tool in the armamentarium of head and neck surgeons . 
 we outline the use of this approach to remove a myolipoma from the tongue base .