Background, Nasopharyngectomy is emerging as an important treatment option
for salvaging locally recurrent nasopharyngeal carcinoma (NPC). After nasop
haryngectomy, 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 graft
s of skin and mucosa for this purpose but have also described significant r
ates of partial and total graft failure.
Methods. We believe that the best and most reliable way to resurface the na
sopharynx is with vascularized tissue, and our preference is for the use of
a free radial forearm flap. To illustrate our approach, we present two pat
ients who underwent nasopharyngectomy by means of a maxillary swing approac
h and who had resurfacing of the surgical defect with a free radial forearm
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 successfu
l resurfacing of the entire nasopharynx. The morbidity of surgery was minim
al, and there were no perioperative complications. On assessment 1 year lat
er, the free radial forearm flap continues to reline the entire neonaso-pha
rynx, 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 excellen
t. (C) 2001 John Wiley & Sons, Inc.