Endoscopic endonasal transpterygoid nasopharyngectomy

Area of Science:

• Otolaryngology
• Surgical Oncology
• Endoscopic Surgery

Background:

• Nasopharyngeal malignancies pose significant treatment challenges.
• Conventional surgical approaches can be invasive with substantial morbidity.
• Minimally invasive endoscopic techniques are emerging for complex head and neck tumors.

Purpose of the Study:

• To describe the endoscopic transpterygoid nasopharyngectomy technique.
• To evaluate the feasibility and early clinical outcomes of this endoscopic approach for nasopharyngeal malignancies.

Main Methods:

• The technique involves extended inferomedial maxillectomy and pterygoid plate removal.
• Mobilization of the pterygopalatine fossa allows access to the posterolateral nasopharynx.
• Crucial control of the internal carotid artery segments is emphasized.

Main Results:

• The study included 20 patients with various histopathologies, including carcinomas and sarcoma.
• 95% of patients achieved negative microscopic margins.
• No perioperative mortality or major complications like CSF leak or stroke occurred; one patient had a transient ICA injury. Overall survival was 45% and local control was 65%.

Conclusions:

• Endoscopic transpterygoid nasopharyngectomy is a feasible and safe option for selected nasopharyngeal cancer patients.
• Preliminary results suggest comparable outcomes to conventional methods.
• The technique is demanding, requiring specialized expertise and equipment.