Avoidance of Maxillary Swing for Nasopharyngectomy via Combined Open Lateral and Endoscopic Approach

Authors

S. Hamad Sagheer, BS, Thomas Jefferson UniversityFollow
Brian Swendseid, MD, Thomas Jefferson UniversityFollow
Joseph M. Curry, MD, Thomas Jefferson UniversityFollow
Mindy Rabinowitz, MD, Thomas Jefferson UniversityFollow
Gurston Nyquist, MD, Thomas Jefferson UniversityFollow
Marc R. Rosen, MD, Thomas Jefferson UniversityFollow
James Evans, MD, Thomas Jefferson UniversityFollow
Adam J. Luginbuhl, Thomas Jefferson UniversityFollow

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Description

Objectives: Nasopharyngectomy performed via a solely endoscopic approach has limitations in access and feasibility, particularly regarding management of the carotid artery. To address these limitations, we report three cases with one cadaver dissection where nasopharyngectomy was performed via a combined open lateral an endoscopic approach. We highlight the benefits and technical considerations for this operative technique.

Study Design: Case Series

Methods: Patients diagnosed with recurrent nasopharyngeal carcinoma (NPC) that underwent combined open lateral and endoscopic nasopharyngectomy from 2016-2020 were analyzed. A cadaver dissection was also performed.

Results: We present the details of the approach and follow-up in three patients with recurrent nasopharyngeal carcinoma. Briefly, a preauricular incision is extended down to the neck. The zygoma and mandibular ramus can be removed and replaced if required. V3, the pterygoid plates and the eustachian tube can be resected or mobilized. The carotid artery may be identified proximally in the neck and traced to the skull base, where the carotid canal may be drilled to the level of the foramen lacerum and protected with a pledget. Then, tumor mucosal cuts are made via an endoscopic endonasal approach and connected to the lateral exposure. No carotid artery injuries occurred.

Conclusion: The combined open lateral approach and endoscopic nasopharyngectomy technique is a useful technique in salvage patients. It provides excellent control of major vessels, adequate access to the carotid canal, V3, and remainder of the skull base, and cervical protection.

Publication Date

2-13-2021

Keywords

Nasopharyngectomy, endoscopic approach, open approach

Disciplines

Medicine and Health Sciences | Otolaryngology

Comments

Presented at the North American Skull Base Society (NASBS) 2021 Annual Meeting

Recommended Citation

Sagheer, BS, S. Hamad; Swendseid, MD, Brian; Curry, MD, Joseph M.; Rabinowitz, MD, Mindy; Nyquist, MD, Gurston; Rosen, MD, Marc R.; Evans, MD, James; and Luginbuhl, Adam J., "Avoidance of Maxillary Swing for Nasopharyngectomy via Combined Open Lateral and Endoscopic Approach" (2021). Department of Otolaryngology - Head and Neck Surgery Posters. 10.
https://jdc.jefferson.edu/otoposters/10