Endoscopic Management of Skull Base Osteoradionecrosis

Abstract

Objective: Osteoradionecrosis is one of the most serious complications in radiotherapy ofnasopharyng al carcinoma. We describe a new endoscopic approach to resolve resultant skull base osteoradionecrosis. The objective of this study is to evaluate the fficacy of endoscopic management of skull base ost oradion crosis. Shidy Design: A prospective study of th outcome of endoscopic management for patient with skull base o teoradionecrosis. Methods: Between 1994 and 1998 six patients who had irradiation previously for nasopharyngeal carcinoma had skull base ost oradionecrosis. A sinoscopic approach was appli d for diagnosis and sequestrectomy. This diagnosis was based on the criterion of exposed necrotic bone after removing aH crust in the nasopharynx and further confirmed on pathological examination after sequestrectomy. Effective cure was defined a intact muco al coverage without any ulcer or expos d n erotic bone observed in the na opharynx and the absence of antecedent accompanying symptoms aft r management. Results: Six patients (100%) were symptom free. Five (83.3%) patients had effective cure. There was no surgical morbidity or mortality. Conclusion: Endoscopic sequestrectomy is a justified approach to skull base osteoradionecrosis.

Postradiation nasopharyngeal necrosis in the patients with nasopharyngeal carcinoma

“…3,11 According to reports in the literature, 4,8,11,12 the endoscopic findings, and clinical features, we suggest that the necrosis procedure could be described as 3 stages: (1) early stage: pathologic changes is located in the nasopharyngeal mucosa; local mucosa denaturalization is the primary endoscopic finding; the patients may have a slight headache or not; foul odor is also unnoticeable; (2) middle stage: pathologic changes develop to soft tissue necrosis, including nasopharyngeal mucosa, muscle, and tendon; filemot necrotic tissue is usually found using endoscopy; headache and foul odor are obvious; (3) severe stage: skull base osteoradionecrosis occurs in this stage. Endoscopic examination shows exposed bone or sequestration in the nasopharynx; headache is unendurable if without analgetic, and foul odor is strong and persistent.…”

Diagnosis and Management of Skull Base Osteoradionecrosis After Radiotherapy for Nasopharyngeal Carcinoma

“…The pathologic examination is very important because sometimes it is difficult to differentiate tumor recurrence from ORN or the two pathologic changes existed at the same time during the operation (we had met one patient after a second course of external beam radiotherapy and brachytherapy; his pathologic examination showed ORN with a little of carcinoma nests; this case was excluded). Chang et al 8 reported that MRI could identify ORN and could show the location and extent but could not provide the specific diagnosis. Single photon emission CT could indicate positive results but could not identify the positive scintigram as a specific lesion of ORN; CT was also not reliable.…”

Differentiation of Recurrent Nasopharyngeal Carcinoma and Skull Base Osteoradionecrosis by Epstein‐Barr Virus‐Derived Latent Membrane Protein‐1 Gene

“… 2 Patients may have a foul odor, ulceration, repeated bleeding, headache, and nasopharyngeal crust accumulation. 3 Patients with recurrent NPC over the primary site may also have ulceration, repeated bleeding, headache, and nasopharyngeal crust formation, all of which might mimic skull base ORN. Clinically, the differentiation between these two different disease entities remains difficult.…”

“…All patients then underwent endoscopic sequestrectomies as we have previously reported. 3 The removed sequestra were sent for pathology verification and determination of the EBV‐derived LMP‐1 gene. After sequestrectomy, all patients still followed a weekly‐based follow‐up protocol until no more bare bone over the skull base was observed.…”