RÉSUMÉ
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.
RÉSUMÉ
BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a relatively safe procedure with comparable safety profile as open thyroidectomy. While gas insufflation complications such as subcutaneous emphysema and pneumomediastinum have been reported postoperatively, there have been no reports of pneumoperitoneum. CASE REPORT: Our patient underwent an uneventful TOETVA to remove her left thyroid lobe. Postoperatively, she developed subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum, which were confirmed on CT scan. She was managed conservatively and recovered uneventfully. CONCLUSION: The authors report the first case of pneumoperitoneum following TOETVA. Surgeons performing TOETVA should be aware of pneumoperitoneum as a possible complication of this procedure after excluding other possible causes.
RÉSUMÉ
BACKGROUND: Grisel's syndrome is rare in adults, and is characterized by nontraumatic atlanto-axial subluxation secondary to infection. Here, we report a case of Grisel's syndrome occurring after endoscopic nasopharyngectomy. METHODS: A 67-year-old man complained of fever and neck pain with reduced lateral rotation after an endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Flexion and extension X-rays of the cervical spine demonstrated atlanto-axial subluxation, and magnetic resonance imaging showed infective changes with cervical osteomyelitis. A diagnosis of Grisel's syndrome with cervical spine osteomyelitis was made. A later computed tomography (CT) scan demonstrated subluxation of C1 on C2, as well as the occipital-C1 joint. RESULTS: The patient was treated with intravenous antibiotics and offered surgery for spinal stabilization, but declined. He remained well 15 months post-op on a cervical collar with minimal pain and no neurologic deficits. CONCLUSION: A high index of suspicion for Grisel's syndrome is suggested in patients who have neck pain with reduced range of motion postnasopharyngectomy, and imaging is useful in clinching the diagnosis. LEVEL OF EVIDENCE: 4.
