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Endoscopic transpterygoid nasopharyngectomy: correlation of surgical anatomy with multiplanar CT
Seid Mousa Sadr Hosseini1, Nancy McLaughlin, Ricardo L Carrau
1Department of Otolaryngology-Head and Neck Surgery, Vali-E-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Background:
Oncologic resection of the nasopharynx is challenging due to its complex and deep-seated nature. We aimed to illustrate the anatomic landmarks of endoscopic nasopharyngectomy and design a surgical training model that could facilitate learning of this technique.
Methods:
An endoscopic endonasal dissection of the nasopharynx was completed in fresh cadaveric specimens under conditions similar to those of our operating suite. Digital data from a high-resolution CT scan were imported to an image guidance system to be used during the dissections.
Results:
We expanded the sinonasal corridor, harvested a contralateral nasoseptal flap, and exposed the pterygopalatine and infratemporal fossae. A detailed anatomic dissection of the nasopharynx was correlated to multiplanar images provided by the image guidance system, highlighting appropriate bony, neural, and vascular landmarks.
Conclusions:
Understanding the anatomy-based endoscopic modular approaches facilitates planning and safe execution of an oncologic nasopharyngectomy. Clinical experience remains mandatory because anatomic models fall short of clinical scenarios.
