Combined craniofacial resection of nasopharyngeal malignancies

Abstract

Nasopharyngeal carcinoma is endemic in south-eastern parts of Asia. Primary treatment modality is definitive radiotherapy ± chemotherapy depending on the stage of disease. Surgery serves as a means of salvage for persistent or recurrent diseases. Maxillary swing operation offers an anterolateral approach for removal of tumors in the nasopharynx ± parapharyngeal space extension including retropharyngeal lymph nodes. Maxillary swing operation may be combined with craniotomy for resection of locally advanced tumors involving the internal carotid artery, temporal bone and temporal dura. Encasement of internal carotid artery warrants prior extracranial intracranial bypass, so that the vessel can be removed en bloc with the tumor to ensure microscopic clearance. Exposed dura, skull base bone and internal carotid artery warrant coverage with well-vascularized muscle flap to facilitate wound healing. Attention to details peri-operation and meticulous tissue handling can help to prevent life threatening complications postoperation.