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September 3, 2020

Reconstruction of Nasopharynx Defect Using a Free Flap After Endoscopic Nasopharyngectomy—Feasibility and Technical Considerations

Author Affiliations
  • 1Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
  • 2Nanyang Technological University, Singapore
  • 3Picasso Plastic Surgery, Mount Elizabeth Novena Hospital, Singapore
  • 4SingHealth Duke-NUS Oncology Academic Clinical Programme, Singapore
  • 5Division of Surgical Oncology, National Cancer Centre, Singapore
JAMA Otolaryngol Head Neck Surg. Published online September 3, 2020. doi:10.1001/jamaoto.2020.2187

Local recurrences of nasopharyngeal carcinomas are uncommon. When they do occur, surgical resection is the standard of care.1 Where the extent of disease allows for it, endoscopic nasopharyngectomy reduces morbidity compared with traditional open techniques.2 Removal of the tumor with a margin typically results in exposure of bone including the clivus and the anterior bodies of the C1/C2 vertebrae. The cervical portion of the carotid artery may also be exposed from the resection. After resection, adequate cover over bone and carotid artery in a previously radiated field is paramount. Typically, the contralateral pedicled reliable nasoseptal flap is used for coverage.3 However, in some cases the nasoseptal flap may be unsafe to use due to the proximity of the tumor. This is especially the case for tumors encroaching the midline and the posterior nasal septum. In these situations, coverage of the resection defect can be achieved by means of a free flap.