Cancer of Nasopharynx
Subcranial Approach
Fig.1 34yrs old female patient with recurrent nasopharyngeal carcinoma sp chemoradiation. Axial CT shows nasopharyngeal growth involving ITF.
Fig.2 Axial MRI shows tumour surrounding horizontal petrous ICA (red ring). White arrow points at the uninvolved contralateral ICA.
Fig.3 Coronal CT shows tumour in nasopharynx and ITF (green arrowhead). Yellow arrow points at the widened foramen ovale.
Fig.4 Coronal MRI shows possible involvement of dura.
Fig.5 Structures to be resected. Greater wing of sphenoid, horizontal petrous carotid artery, ramus & entire content of ITF and nasopharynx.
Fig.6 Since there was good cross circulation, the ipsilateral ICA was permanently occluded (yellow arrow) distal to the area to be resected. Red arrow points at the stoppage of blood flow through ICA in the neck.
Fig.7 Incision as marked. Upper & lower cheek flaps are raised to expose mid and lower facial skeleton.
Fig.8 Osteotomies at the angle mandible, posterior part of maxilla and greater wing of sphenoid . Ramus (brown) with the content of ITF, posterior part of maxilla & pterygoid plates (Green), greater wing of sphenoid (blue) and nasopharynx resected.
Fig.9 After resection of tumour.
Fig.10 Closeup view showing cut end of ICA before entering cavernous sinus, sphenoid sinus and middle fossa dura (excised and repaired with fascia lata).
Fig.11 CT shows the extent of surgical defect reconstructed with rectus abdominis microvascularflap (yellow arrows).
Fig.12 Post-op photograph. Mild facial paresis from retraction.
The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)
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The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)