Premium
Endoscopic endonasal transpterygoid nasopharyngectomy
Author(s) -
AlSheibani Salma,
Zanation Adam M.,
Carrau Ricardo L.,
Prevedello Daniel M.,
Prokopakis Emmanuel P.,
McLaughlin Nancy,
Snyderman Carl H.,
Kassam Amin B.
Publication year - 2011
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.22165
Subject(s) - medicine , pterygopalatine fossa , surgery , internal carotid artery , clivus , perioperative , radiology , skull
Objective: Describe our technique for endoscopic transpterygoid nasopharyngectomy and support its feasibility with our early clinical outcomes. Methods: Our endoscopic technique comprises an extended inferomedial maxillectomy, mobilization of the pterygopalatine fossa, removal of the pterygoid plates and Eustachian tube to access the posterolateral nasopharynx. Control of the parapharyngeal and petrous segments of the internal carotid artery is the keystone of the approach. Results: Various histopathologies were treated, including epidermoid carcinomas (n = 9), lymphoepithelioma (n = 1), adenoid cystic carcinoma (n = 5), adenocarcinoma (n = 2), mucoepidermoid carcinoma (n = 2), and sarcoma (n = 1). Negative microscopic margins were obtained in 95% (19/20) of patients. No perioperative mortality, cerebral spinal fluid (CSF) leak, meningitis, or cerebrovascular accident was encountered; however, one patient suffered an internal carotid artery (ICA) injury, without permanent sequelae. All but one patient received adjuvant therapy (external and/or stereotactic radiotherapy with or without chemotherapy). Follow‐up ranged from 15 to 68 months (mean = 33). Overall survival was 45% (9/20) and local control was 65% (13/20). Conclusions: Endoscopic transpterygoid nasopharyngectomy for primary and recurrent nasopharyngeal malignancies is feasible and safe in properly selected patients. Preliminary outcomes compare to that of conventional techniques. Endoscopic resections, however, are demanding; they require specialized equipment and a team versed in endoscopic oncologic surgery. Long‐term follow‐up and reproducibility remain undefined.