Endoscopic transpterygoid nasopharyngectomy: correlation of surgical anatomy with multiplanar CT

Head Neck. 2013 May;35(5):704-14. doi: 10.1002/hed.23020. Epub 2012 Jun 19.

Abstract

Background: Oncologic resection of the nasopharynx is challenging due to its complex and deep-seated nature. We aimed to illustrate the anatomic landmarks of endoscopic nasopharyngectomy and design a surgical training model that could facilitate learning of this technique.

Methods: An endoscopic endonasal dissection of the nasopharynx was completed in fresh cadaveric specimens under conditions similar to those of our operating suite. Digital data from a high-resolution CT scan were imported to an image guidance system to be used during the dissections.

Results: We expanded the sinonasal corridor, harvested a contralateral nasoseptal flap, and exposed the pterygopalatine and infratemporal fossae. A detailed anatomic dissection of the nasopharynx was correlated to multiplanar images provided by the image guidance system, highlighting appropriate bony, neural, and vascular landmarks.

Conclusions: Understanding the anatomy-based endoscopic modular approaches facilitates planning and safe execution of an oncologic nasopharyngectomy. Clinical experience remains mandatory because anatomic models fall short of clinical scenarios.

MeSH terms

  • Dissection
  • Endoscopy
  • Humans
  • Maxilla / surgery
  • Nasopharynx / anatomy & histology*
  • Nasopharynx / surgery*
  • Pharyngectomy / education
  • Pharyngectomy / methods*
  • Pterygopalatine Fossa
  • Sphenoid Bone / surgery
  • Tomography, X-Ray Computed* / methods