gms | German Medical Science

Nasopharyngectomy for recurrent nasopharyngeal carcinoma (rNPC) using an endoscopic technique is less invasive than traditional methods. Our primary purpose is to identify the important anatomic landmarks so the endoscopic surgeon can avoid injury to the internal carotid artery (ICA) and perform a nasopharyngectomy safely. The secondary purpose is to evaluate the efficacy of this novel approach.Transnasal endoscopic dissection was carried out on 3 fresh adult cadaver specimens (6 sides). Measurements were made in 50 adult skulls (100 sides), detailing the distances between orienting critical landmarks and the internal carotid canal (external aperture). Thirty-seven rNPC patients (rT1-rT3) who received endoscopic nasopharyngectomy during the period of 2004 to 2008 were reviewed retrospectively.Anatomy of the operative field (endoscopic view) is described. Orientating topical landmarks include: posterior portions of the inferior turbinate and nasal septum and the torus tubarius. The deep landmarks include: medial pterygoid plate - posterior margin at the skull base, Eustachian tube isthmus, foramen lacerum and the longus capitis. All topical and deep landmarks were identified from the endoscopic point of view and their distances to the internal carotid canal (external aperture) were measured. Among the 37 endoscopic nasopharyngectomies, 35 achieved en bloc tumor resection with negative surgical margins. The 2-year overall survival rate was 84.2%.Appropriate endoscopic nasopharyngectomy is a minimally invasive, safe, and promising surgical modality for the en bloc excision of rNPCs with encouraging short-term outcome. Surgeons can efficiently and safely deal with rNPC endoscopically using the above orienting landmarks. However, Long-term patient follow-up is ongoing.