Novel Endoscopic Transnasal Technique for Anterolateral Thigh Flap Inset Post Nasopharyngeal Carcinoma Resection

Post-nasopharyngectomy reconstruction for recurrent nasopharyngeal carcinomas has been used for defect coverage and protection of vital structures. With the increasing use of endoscopic transnasal nasopharyngeal extirpation to offset complications faced with open techniques, there is a need for corresponding reconstructive support through a similar approach. We describe a novel endoscopic transnasal anterolateral thigh flap inset technique, combined with a transverse neck incision, in two patients who underwent transnasal nasopharyngectomy. We also include a video presentation of our operative technique. A vastus lateralis fascia free flap was used for one patient, and a vastus lateralis muscle free flap for the other. Both patients were aged 51 years. Mean nasopharyngeal defect size was 20 cm² (range 12-28 cm²). Average surgical stay was 13.5 days (11-16 days) and flap mucosalization was complete for both patients. No recipient site complications were observed in either patient, although donor site seroma formation was seen in one patient. Average time to speech recovery was 1.5 months (range 1-2 months) for both patients. Time to diet recovery was 2 months for one patient, whereas the other was on long-term percutaneous endoscopic gastrostomy feeding. There were no flap failures or peri-operative mortalities. Endoscopic transnasal anterolateral thigh flap inset to reconstruct the nasopharyngeal space is an effective technique that confers reduced morbidity and potentially better outcomes compared with open techniques.