Use of a posterior pedicle nasal septum and floor mucoperiosteum flap to resurface the nasopharynx after endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma
Corresponding Author
Ming–Yuan Chen MD, PhD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Ming-Yuan Chen, Shun–Lan Wang, and Yu–Liang Zhu contributed equally to this work.
Ming–Yuan Chen, Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Ming–Huang Hong, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorShun–Lan Wang MD
Department of Otorhinolaryngology, First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, 16 Airfield Rd, Guangzhou 510405, Peoples Republic of China
Ming-Yuan Chen, Shun–Lan Wang, and Yu–Liang Zhu contributed equally to this work.
Search for more papers by this authorYu–Liang Zhu MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Ming-Yuan Chen, Shun–Lan Wang, and Yu–Liang Zhu contributed equally to this work.
Search for more papers by this authorGuo–Ping Shen MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorFang Qiu MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorDong–Hua Luo MD, PhD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorQiu–Yan Chen MD, PhD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorRou Jiang MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorKa–Jia Cao MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorChao–Nan Qian MD, PhD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorCorresponding Author
Ming–Huang Hong MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Ming–Yuan Chen, Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Ming–Huang Hong, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorCorresponding Author
Ming–Yuan Chen MD, PhD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Ming-Yuan Chen, Shun–Lan Wang, and Yu–Liang Zhu contributed equally to this work.
Ming–Yuan Chen, Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Ming–Huang Hong, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorShun–Lan Wang MD
Department of Otorhinolaryngology, First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, 16 Airfield Rd, Guangzhou 510405, Peoples Republic of China
Ming-Yuan Chen, Shun–Lan Wang, and Yu–Liang Zhu contributed equally to this work.
Search for more papers by this authorYu–Liang Zhu MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Ming-Yuan Chen, Shun–Lan Wang, and Yu–Liang Zhu contributed equally to this work.
Search for more papers by this authorGuo–Ping Shen MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorFang Qiu MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorDong–Hua Luo MD, PhD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorQiu–Yan Chen MD, PhD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorRou Jiang MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorKa–Jia Cao MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorChao–Nan Qian MD, PhD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorCorresponding Author
Ming–Huang Hong MD
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Ming–Yuan Chen, Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Ming–Huang Hong, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China
Search for more papers by this authorAbstract
Background
Endoscopic nasopharyngectomy is a new salvage treatment for locally recurrent nasopharyngeal carcinoma (NPC). However, how to resurface the nasopharyngeal defects in endoscopic endonasal approaches to avoid persistent postoperative headache, to the best of our knowledge, has not been reported.
Methods
From September 2009 to August 2010, we used a modified posterior pedicle nasal septum and floor mucoperiosteum flap (nasal septum and floor flap, NSFF) after endoscopic nasopharyngectomy in 12 patients with locally recurrent NPC. Most of the nasal septum and floor mucoperiosteum, except for the posterior pedicle, was harvested to cover the nasopharyngeal defects.
Results
All NSFFs successfully covered the entire nasopharyngeal defects and relined the nasopharynx with good functional recovery. The nasopharyngeal wounds recovered in 28 days (range, 14 to 56 days), and the donor-site wounds recovered in 46.5 days (range, 24–84 days). No reconstruction-related complications or disease recurrences were observed.
Conclusion
The NSFF is a safe and promising reconstructive option to resurface the nasopharyngeal defect after endoscopic nasopharyngectomy in patients with locally recurrent NPC. © 2011 Wiley Periodicals, Inc. Head Neck, 2011
REFERENCES
- 1 Chen MY, Wen WP, Guo X, et al. Endoscopic nasopharyngectomy for locally recurrent nasopharyngeal carcinoma. Laryngoscope 2009; 119: 516–522.
- 2 Chen MK, Lai JC, Chang CC, Liu MT. Minimally invasive endoscopic nasopharyngectomy in the treatment of recurrent T1–2a nasopharyngeal carcinoma. Laryngoscope 2007; 117: 894–896.
- 3 Yoshizaki T, Wakisaka N, Murono S, Shimizu Y, Furukawa M. Endoscopic nasopharyngectomy for patients with recurrent nasopharyngeal carcinoma at the primary site. Laryngoscope 2005; 115: 1517–1519.
- 4 Ko JY, Wang CP, Ting LL, Yang TL, Tan CT. Endoscopic nasopharyngectomy with potassium-titanyl-phosphate (KTP) laser for early locally recurrent nasopharyngeal carcinoma. Head Neck 2009; 31: 1309–1315.
- 5 Chen MY, Guo X, Wen WP, et al. [Salvage surgical operation via endoscopic transnasal approach for local persistent or recurrent nasopharyngeal carcinoma]. Ai Zheng 2007; 26: 673–678.
- 6 Greene FL, Page DL. 2002 AJCC Cancer Staging Handbook, 6th ed. Springer–Verlag Publication; New York. pp 50.
- 7 Cho JH, Kim SW, Park YJ. Mucoperiosteal rotating flap for repairing nasal septal perforations: how we do it. Clin Otolaryngol 2009; 34: 245–250.
- 8 Stewart TL, Fisher DM, Olson JL. Modified Von Langenbeck cleft palate repair using an anterior triangular flap: decreased incidence of anterior oronasal fistulas. Cleft Palate Craniofac J 2009; 46: 299–304.
- 9 Oliver CL, Hackman TG, Carrau RL, et al. Palatal flap modifications allow pedicled reconstruction of the skull base. Laryngoscope 2008; 118: 2102–2106.
- 10 Khoo ML, Soo KC, Gullane PJ, et al. Resurfacing of the nasopharynx after nasopharyngectomy using a free radial forearm flap. Head Neck 2001; 23: 916–922.
- 11 Hadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116: 1882–1886.
- 12 Pinheiro–Neto CD, Prevedello DM, Carrau RL, et al. Improving the design of the pedicled nasoseptal flap for skull base reconstruction: a radioanatomic study. Laryngoscope 2007; 117: 1560–1569.
- 13 Shah RN, Surowitz JB, Patel MR, et al. Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. Laryngoscope 2009; 119: 1067–1075.
- 14 El–Sayed IH, Roediger FC, Goldberg AN, Parsa AT, McDermott MW. Endoscopic reconstruction of skull base defects with the nasal septal flap. Skull Base 2008; 18: 385–394.
- 15 Fortes FS, Carrau RL, Snyderman CH, et al. The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction. Laryngoscope 2007; 117: 1329–1332.
- 16 Kilty SJ, Brownrigg PJ, Safar A. Nasal septal perforation repair using an inferior turbinate flap. J Otolaryngol 2007; 36: 38–42.
- 17 Friedman M, Ibrahim H, Ramakrishnan V. Inferior turbinate flap for repair of nasal septal perforation. Laryngoscope 2003; 113: 1425–1428.
- 18 Prevedello DM, Barges–Coll J, Fernandez–Miranda JC, et al. Middle turbinate flap for skull base reconstruction: cadaveric feasibility study. Laryngoscope 2009; 119: 2094–2098.
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