Stepwise Tumor Tailored Endoscopic Nasopharyngectomy Classification

Endoscopic nasopharyngectomy has recently been reported for recurrent nasopharynx cancer with adequate control rates. Selection criteria are not well defined though. Further, most approaches to the nasopharynx whether open or endoscopic only describe the surgical access obtained, such as a maxillary swing or “endoscopic approach” and do not describe the detailed anatomic steps?

Hypothesis: An endoscopic nasopharyngectomy can be described tailored to extent of disease and incorporating key anatomic landmarks that predict unresectability or undue morbidity.

Methods: We dissected five anatomic cadavers for anatomic detail and high definition images.

Results: We developed four types of nasopharyngectomy correlated with potential recurrence patterns predicted on the concept of obtaining a 1cm margin of clean tissue. Dissections are based around Type 1 limited nasopharynx approach, Type II transsphenoid approach for tumors involving the anterior sphenoid wall, Type III transpterygoid approach to expose the carotid artery and remove the Eustachian tube for tumors of the lateral pharyngeal recess, and Type IV–transmasticator space approach for tumors invading the parapharyngeal space.

Results: We present a step by step anatomic approach to perform a tailored nasopharyngectomy for appropriate T1 and T2 recurrent nasopharynx cancer. High-definition images are used to demonstrate the key anatomic structures. These procedures will allow resection with up to a 1cm margin or anatomic plane to allow at least close margin resection. This study help better define the surgical procedure of nasopharyngectomy.