Familial Nasopharyngeal Carcinoma 6

Surgery for Recurrent Nasopharyngeal Carcinoma 263GzFig. 20.18. The right maxilla is retracted laterally by a pieceof gauz (Gz) to expose the tumor in the nasopharynx (arrowheads)bloc (Fig. 20.19). With the resection of the posteriorpart of the nasal septum, tumor extended across themidline can also be adequately removed up to the edgeof the opposite medial crura of the opening of theauditory tympanic tube. After the maxilla has beenswung laterally, the dissection of the paranasopharyngealLN can be done under direct vision. The internalcarotid artery outside the pharyngobasilar fascia canbe palpated and safe guarded during the dissection.The mortalities associated with these salvage surgicalprocedures have been generally low and acceptable.As all these patients had previously undergone radicalradiotherapy, complete wound healing might takesome time. One of the initial complications associatedwith the maxillary swing approach was the developmentof a palatal fistula (Wei 2001). These patientshave to wear a dental plate for swallowing and speech.Recently, the incision over the palate have beenmodified, the incision on the soft tissue and the osteotomysites were designed to at different sites (Figs. 20.20and 20.21) and this eliminated the formation of palatalfistula associated with this operation (Ng and Wei2005). Many patients developed trismus after thenasopharyngectomy with the anterolateral approach,and this was related to the fibrosis of the pterygoidmuscle following radiotherapy and surgery. This ingeneral responded to passive stretching and did notaffect significantly the quality of life of these patientswho had undergone salvage nasopharyngectomy (Ngand Wei 2006). In general, as long as the persistent orrecurrent tumor can be resected with a clear margin,the long-term results have been satisfactory. The 5-yearactuarial control of tumors in the nasopharynx followingsalvage nasopharyngectomy has been reported tobe around 65% and the 5-year disease-free survivalrate is around 54% (Fee et al. 2002; Wei 2003).Fig. 20.19. The resected nasopharynx with the yellow tubemarking the right Eustachian tube opening. The tumor (T)is resected with marginFig. 20.20. The incision on the hard palate is modified to bea curved one, along the inner border of the upper alveolus20.5SummaryLocal and/or regional recurrence after definitivetreatment of NPC is a major concern of treatmentfailure. Although combined chemotherapy and reirradiationcould be considered to treat the recurrentlesions in both neck and nasopharynx, a second