Resurfacing of the nasopharynx after nasopharyngectomy using a free radial forearm flap

• Published in: Head & neck 2001-10, Vol.23 (10), p.916-922
• Main Authors: Khoo, Mark L. C., Soo, Khee‐Chee, Gullane, Patrick J, Neligan, Peter C, Hong, Soo‐Wan, Lee, Julian C. Y., Siow, Jin‐Keat
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; free radial forearm flap; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Lymph Node Excision; Male; Medical sciences; Middle Aged; Nasopharyngeal Neoplasms - diagnostic imaging; Nasopharyngeal Neoplasms - surgery; nasopharyngectomy; Nasopharynx - diagnostic imaging; Nasopharynx - surgery; Otorhinolaryngology. Stomatology; Pharyngectomy; resurfacing nasopharynx; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Surgical Flaps; Tomography, X-Ray Computed; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.1132

Background Nasopharyngectomy is emerging as an important treatment option for salvaging locally recurrent nasopharyngeal carcinoma (NPC). After nasopharyngectomy, resurfacing the nasopharynx and covering the internal carotid artery is important to minimize the risk of infection, osteoradionecrosis, and carotid rupture. Previous authors have advocated the use of free grafts of skin and mucosa for this purpose but have also described significant rates of partial and total graft failure. Methods We believe that the best and most reliable way to resurface the nasopharynx is with vascularized tissue, and our preference is for the use of a free radial forearm flap. To illustrate our approach, we present two patients who underwent nasopharyngectomy by means of a maxillary swing approach and who had resurfacing of the surgical defect with a free radial forearm flap. Results Both patients had complete en bloc resection of tumor followed by the insetting of a free radial forearm flap to reline the surgical defect. Both flaps remained completely viable, and both patients achieved successful resurfacing of the entire nasopharynx. The morbidity of surgery was minimal, and there were no perioperative complications. On assessment 1 year later, the free radial forearm flap continues to reline the entire neonasopharynx, and the long‐term functional recovery after surgery is excellent. Conclusion Resurfacing the nasopharynx after nasopharyngectomy with a free radial forearm flap aids healing and minimizes the risk of complications. The morbidity of surgery is minimal and the functional recovery is excellent.23: © 2001 John Wiley & Sons, Inc. Head Neck 23: 916–922, 2001.