Types of Transnasal Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: Shanghai EENT Hospital Experience

Liu, Quan; Sun, Xicai; Li, Han; Zhou, Jiaju; Gu, Yurong; Zhang, Weidong; Li, Houyong; Yu, Huilin; Wang, Dehui

doi:10.3389/fonc.2020.555862

Cited by 21 publications

(24 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…29 If the reflex pressure is less than 60 mm Hg, implantation of the covered stent under guidance of DSA can help enhance the safety of procedures surrounding the parapharyngeal ICA. 34 However, it is difficult to achieve a negative margin in this clinical setting.…”

Section: Discussionmentioning

confidence: 99%

An Endoscopic Endonasal Nasopharyngectomy with Posterolateral Extension

London

Prevedello

et al. 2021

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Background Invasion depth influences the choice for extirpation of nasopharyngeal malignancies. This study aims to validate the feasibility of endoscopic endonasal resection of lesions with a posterolateral invasion. As a secondary goal, the study intends to propose a classification system of endoscopic endonasal nasopharyngectomy determined by the depth of posterolateral invasion. Methods Eight cadaveric specimens (16 sides) underwent progressive nasopharyngectomy using an endoscopic endonasal approach. Resection of the torus tubarius, Eustachian tube (ET), medial pterygoid plate and muscle, lateral nasal wall, and lateral pterygoid plate and muscle were sequentially performed to expose the fossa of Rosenmüller, petroclival region, parapharyngeal space (PPS), and jugular foramen, respectively. Results Technical feasibility of endonasal nasopharyngectomy toward a posterolateral direction was validated in all 16 sides. Nasopharyngectomy was classified into four types as follows: (1) type 1: resection restricted to the posterior or superior nasopharynx; (2) type 2: resection includes the torus tubarius which is suitable for lesions extended into the petroclival region; (3) type 3: resection includes the distal cartilaginous ET, medial pterygoid plate, and muscle, often required for lesions extending laterally into the PPS; And (4) type 4: resection includes the lateral nasal wall, pterygoid plates and muscles, and all the cartilaginous ET. This extensive resection is required for lesions involving the carotid artery or extending to the jugular foramen region. Conclusion Selected lesions with posterolateral invasion into the PPS or jugular foramen is amenable to a resection via expanded endonasal approach. Classification of nasopharyngectomy based on tumor depth of posterolateral invasion helps to plan a surgical approach.

show abstract

Section: Discussionmentioning

confidence: 99%

An Endoscopic Endonasal Nasopharyngectomy with Posterolateral Extension

London

Prevedello

et al. 2021

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

show abstract

“…The lingual and inferior alveolar nerves on the posteromedial side of the external pterygoid muscle were located, and the middle meningeal artery and sphenoid spine were exposed posteriorly (Figure 1C, D, E). We categorized transnasal endoscopic nasopharyngectomy (TEN) into four types: type I, with resection of the nasopharynx and sinuses; type II, with lateral extension to the parapharyngeal space; type III, with lateral extension to the floor of the middle cranial fossa and the infratemporal fossa and superior extension to the orbital apex and the cavernous sinus back to the prevertebral region; and type IV, with additional resection of the involved ICA following the type III procedure (11) .…”

Section: Surgical Proceduresmentioning

confidence: 99%

Salvage endoscopic surgery for skull base osteoradionecrosis in nasopharyngeal carcinoma patients: A prospective, observational, single-arm clinical study

Dai

Shi

Zhang

et al. 2022

Rhin

View full text Add to dashboard Cite

Background: Postradiation skull base osteoradionecrosis (ORN) is a severe complication that occurs after radiotherapy in patients with nasopharyngeal carcinoma (NPC) that can severely affect quality of life (QOL) and be life threatening. Only 13.4%–28.6% of patients can be cured by traditional repeated endoscopic debridement. Here, we introduced salvage endoscopic surgery for skull base ORN patients and evaluated its clinical efficacy. Methods: This was a prospective, observational, single-arm clinical study. Clinical data from 18 skull base ORN patients who underwent radical endoscopic necrectomy followed by reconstruction using a septal pedicled mucosal flap or temporal muscle flap were included in the study. The endpoint was an overall survival (OS) of 2 years. The numeric rating scale (NRS) scores for pain and foul odor were analyzed to determine the efficacy and safety of this surgery. Results: A total of 21 patients were recruited, 18 of whom completed the study and were analyzed. All surgeries were successfully performed. During the 2-year study, the OS rate of the entire cohort was 75%. The median NRS score for pain decreased from 6.44±2.62 to 0.50 ±0.71, and the NRS score for foul odor decreased from 1.89±1.08 to 1 after surgery. Conclusions: Salvage endoscopic necrectomy followed by construction using a septal pedicled mucosal flap or temporal muscle flap is a novel, safe, and effective treatment for ORN in patients with NPC. Clinical trial registration: This study was approved by the independent ethics committee of the Eye, Ear, Nose and Throat Hospital of Fudan University (IEC No. 2019095-1). Written informed consent was obtained from all patients. The study was registered with the Chinese Clinical Trial registry (ChiCTR2000029327).

show abstract

“…Therefore, the defect requires an adequately sized tissue flap for repair and coverage. Because the nasopharynx is surrounded by bony structures, the only adjacent tissue that can be used for a flap is the nasal mucosa ( 14 , 15 ). A nasal septal mucosal flap with the pedicle located in the anterior wall of the sphenoid sinus had the largest tissue volume; however, the blood supply of the nasal septal valve was easy to be affected by nasopharyngeal malignant invasion, preventing the flap from being used.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of nasopharyngeal defect with submental flap during surgery for nasopharyngeal malignant tumors

Fang¹,

Hou²,

Li³

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

ObjectiveTo investigate the feasibility and effect of a pedicled submental flap in postoperative defect repair of nasopharyngeal malignant tumors.MethodsEight cases (six women, two men; age, 29–63 years) of postoperative defects after resection of malignant nasopharyngeal tumors with a lesion stage of (r) T1–3N0–2M0 were retrospectively analyzed. Preoperative enhanced thin-slice computed tomography of the neck was performed to predict the submental flap reflux vein. The submental flap was prefabricated during the operation, and the nasopharyngeal mass was removed through the parapharyngeal space approach combined with nasal endoscopy/mandibular external rotation/maxillary overturning. The submental flap was elevated to the nasopharyngeal defect area through the parapharyngeal space for repair.ResultsIntraoperative examination confirmed that among the eight submental flaps, three had venous drainage into the internal jugular vein and five had venous drainage into the external jugular vein; these findings were consistent with the preoperative computed tomography findings. The size of the submental flap was 8–10 cm × 5–6 cm. The repair range reached the eustachian orifice on the healthy side and extended to the posterior wall of the maxillary sinus on the affected side. The flap extended to the posterior upper part of the nasal septum at the top, to the oropharynx at the bottom, and to the bony surface of the skull base at the deep side. Primary healing after surgery was achieved, and no flap necrosis occurred. After 3–77 months of follow-up, one patient with recurrent nasopharyngeal carcinoma after radiotherapy developed cervical lymph node recurrence again, one patient with adenoid cystic carcinoma had lung metastasis, and the remaining six patients had no recurrence.ConclusionsThe pedicled submental flap is used to repair postoperative defects in the nasopharyngeal region through the cervical parapharyngeal space. It is a simple and fast procedure with adequate tissue volumes. The flap can effectively protect important structures such as the internal carotid artery and reduce the risk of infection and bleeding from postoperative wound exposure.

show abstract

Types of Transnasal Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: Shanghai EENT Hospital Experience

Cited by 21 publications

References 22 publications

An Endoscopic Endonasal Nasopharyngectomy with Posterolateral Extension

An Endoscopic Endonasal Nasopharyngectomy with Posterolateral Extension

Salvage endoscopic surgery for skull base osteoradionecrosis in nasopharyngeal carcinoma patients: A prospective, observational, single-arm clinical study

Reconstruction of nasopharyngeal defect with submental flap during surgery for nasopharyngeal malignant tumors

Contact Info

Product

Resources

About