Maxillary swing approach for surgical resection of recurrent nasopharyngeal tumors

Purpose : To evaluate the efficacy of salvage nasopharyngectomy for locally recurrent nasopharyngeal tumors through the maxillary swing approach. Methods : Antero -lateral access to the nasopharynx and its vicinity through the maxillary swing approach was used. Through a Weber-Fergusson-Longmire incision, the whole maxilla is freed and swung laterally while remaining attached to the masseter muscle and cheek flap. The nasopharynx, para-pharyngeal space and infratemporal fossa are now exposed facilitating complete resection of the tumor. Results : Seven patients were treated with this approach at the National Cancer Institute, Cairo University. There were 6 males and one female with a range of age 16-57 years. Three patients had recurrent carcinoma of the nasopharynx after primary radiation therapy, while four patients had locally advanced recurrent juvenile nasopharyngeal angiofibroma (JNA). Using the operating microscope, complete tumor resection was achieved in all patients except one patient with intracranial extension of JNA. There was no surgical mortality. Complications occurred in three patients, one patient developed osteoradionecrosis following re-irradiation, a patient had epiphora while palatal fistula occurred in another patient. The follow-up period ranged from 3 months to 6 years, one patient died from distant disease and another patient is alive with residual intra-cranial disease. Conclusion : Salvage nasopharyngectomy is a valid option for selected patients with recurrent nasopharyngeal tumors. The maxillary swing approach allows safe and complete resection for nasopharyngeal carcinoma as well as juvenile angiofibroma with intracranial extension. Key Words : Recurrent nasopharyngeal tumors -Salvage nasopharyngectomy -Juvenile nasopharyngeal angiofibroma.