Vasculaized flap to cover nasopharyngeal defects
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AbstractWith the improvement of endoscopic instruments and development of binostrils 4-hands technique, endoscopic nasopharyngectomy can feasibility excise early recurrent nasopharyngeal cancer (rT1, rT2a) and selected advanced (rTb and rT3) diseases. The next challenge is to cover the defect to prevent osteoradionecrosis. Nasoseptal flap is a reliable vascular flap based on the posterior septal artery (PSA) of the sphenopalatine artery. PSA divides into superior and inferior branches ether lateral (2/3) or medial (1/3) to the sphenoid ostium. The main stem or the superior branch can be 1mm as close as to the sphenoid ostium. So injury of the pedicle is possible in sphenoidotomy. Post radiation cases would increase the chance of flap failure. Lastly, tumor involvement of the sphenoid floor and rostrum would jeopardize the choice of using nasoseptal flap. Inferior turbinate flap is an alternative vascular flap to cover the nasopharyngeatomy defect. It is based on the posterior lateral nasal artery of the sphenopalatine artery. However, the size of the flap is not as large as nasoseptal flap. Inferior meatal mucosal wall and even part of the nasal floor mucosa can be used to enlarge the size of the flap. Temporoparietal fascia flap based on the superficial temporal artery is another alternative vascular flap. Lateral scalp incision is necessary to harvest the flap. The flap passed medial to the zygomatic arch and pass through a pathway in the pterygoid region created by endoscopic medial maxillectomy and removal of posterior and lateral wall of maxilla. The flap can reach to the contralateral Fossa of Rosseunmullar of the nasopharynx. We would share a case of using temporoparietal fascial flap after failure of nasoseptal and inferior turbinate flap.
All Author(s) ListDennis LY Lee, Ryan HW Cho, Michael CF Tong
Journal nameJapanese Journal of Rhinology
Volume Number57
Issue Number3
PublisherJapan Rhinologic Society
Place of PublicationJapan
Pages352 - 352
LanguagesEnglish-United Kingdom

Last updated on 2019-26-02 at 09:58