Anatomical studies and early results on endoscopic transoral medial pterygomandibular fold approach to salvage retropharyngeal lymphadenectomy in nasopharyngeal carcinoma.

OBJECTIVE: Retropharyngeal lymphadenectomy is challenging. This study investigated a minimally invasive approach to salvage retropharyngeal lymphadenectomy in patients with nasopharyngeal carcinoma. METHODS: An anatomical study of four fresh cadaveric heads was conducted to demonstrate the relevant details of retropharyngeal lymphadenectomy using the endoscopic transoral medial pterygomandibular fold approach. Six patients with nasopharyngeal cancer with retropharyngeal lymph node recurrence, who underwent retropharyngeal lymphadenectomy with the endoscopic transoral medial pterygomandibular fold technique at the Eye and ENT Hospital of Fudan University from July to December 2021, were included in this study. RESULTS: The anatomical study demonstrated that the endoscopic transoral medial pterygomandibular fold approach offers a short path and minimally invasive approach to the retropharyngeal space. The surgical procedure was well tolerated by all patients, with no significant post-operative complications. CONCLUSION: The endoscopic transoral medial pterygomandibular fold approach is safe and efficient for retropharyngeal lymphadenectomy.

Endonasal Endoscopic Resection and Radiotherapy in Skull Base Chordomas.

OBJECTIVES: This study evaluates the impact combined endonasal endoscopic resection and radiotherapy for skull base chordomas. METHODS: Thirty-two patients with skull base chordomas between July 2006 and June 2015 were divided into 2 groups: the surgery alone group and the surgery with radiation therapy group. RESULTS: Gross total resection was achieved in 9 (28.1%) patients with skull base chordoma, subtotal resection was achieved in 16 (50.0%) patients, and partial resection was achieved in 7 (21.9%) patients. The progression-free survival (PFS) rate at 3 and 5 years was 44.0% and 16.5%, respectively. The overall survival (OS) rate at 3 and 5 years was 79.4% and 69.5%, respectively. Kadish staging predicted PFS and OS with statistical significance when the extent of resection was categorized into gross total resection, subtotal resection, and partial resection (P = 0.035 and P = 0.003, respectively). There was a significant OS advantage for the surgery plus radiation group compared with the surgery alone group (P = 0.035). CONCLUSION: Gross total resection can achieve very good results for the treatment of skull base chordomas. Postoperative adjuvant radiation therapy is recommended for all skull base chordomas, as it offered a higher OS rate.

Endoscopic Repair of the Injured Internal Carotid Artery Utilizing Oxidized Regenerated Cellulose and a Free Fascia Lata Graft.

OBJECTIVE: To introduce appropriate surgical procedures for the endoscopic repair of the internal carotid artery (ICA) injury. METHODS: Two patients with ICA injury during the endoscopic endonasal approach surgery were reviewed. RESULTS: Internal carotid artery injury during the endonasal skull-base approach was a rare complication. Once ICA injury occurred, 2 large bore suctions were placed immediately for drainage and the bleeding point was located. Then, an oxidized regenerated cellulose was quickly pressed onto the bleeding point and was held there to stop the bleeding. Afterward, a free graft of fascia lata was inserted and the free fat graft was compressed for repair. Absorbable packing materials were used for nasal packing. CONCLUSIONS: Endoscopic repair utilizing oxidized regenerated cellulose and a free fascia lata graft is a safe and feasible surgical option for ICA injury.

Management of nasopharyngeal angiofibroma in a 72-year-old male through a sublabial and buccolabial incision approach: A case report and literature review.

Nasopharyngeal angiofibroma (NA) primarily affects adolescent males. The incidence of NA in the elderly, however, is extremely low. The present study describes a 72-year-old male with NA that presented with typical symptoms and radiological findings. The location and extension of the tumor was too lateral and inferior to be effectively resected by an endoscopic approach. Therefore, a combination of endoscopic and open approaches was considered. The tumor was completely resected using an image-guided endoscopic-assisted sublabial and buccolabial incision approach. The post-operative histopathological and immunohistochemical analysis confirmed the diagnosis of NA. The present study demonstrated the occurrence of NA in the elderly, and highlighted the potential of an image-guided endoscopic-assisted sublabial and buccolabial incision approach for the treatment of NA in the elderly.