Specialities » Head and Neck Tumour Surgery » Cancer of Nasopharynx » Subcranial Approach

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)

Mithun Das

03:35 18 Mar 23

Its a pleasure experience with Dr. Rayappa C. We came for my wife thyroid nodules operation and testing for cancer malignancy. Doctor taken care everything with my previous diagnosis report and suggest to surgery half of thyroid infected lob.After this operation we got biopsy report that indicate still cancer not affected.Thanks to doctor and wishes him all the very best.

Saima Hasin

07:07 13 Mar 23

A sincere and dedicated doctor. He treated my husband for Oral Cancer. He gave his best efforts to overcome the disease. With patience and sincerity he handled the post surgery stages. We are so thankful to him. Expressing our gratitude to Almighty Allah and of course to Dr.Rayappa for his recovery .

Reyad Alam

16:49 16 Feb 23

Just saying ‘Thank you’ will not justify what Dr. Rayappa sir has done for us.My mom was having difficulty in breathing for merely 2 years due to thyroid enlargement.So we consulted Dr.Rayappa and he asked us to do surgery as soon as possible. It was hard for us to take the decision since a lot of risks was involved but we went ahead with it.Post surgery - My mom feels so energetic and alive, which she never felt before. Can breathe better, can talk, and just recovered in 2 days. The surgery was a success and Dr. Rayappa and his team took great for us throughout. We can’t describe the joy and happiness we’re filled with to see my mother so healthy.We give our heartfelt gratitude to Dr.Rayappa sir and his team.Dr. Rayappa is a great Otolaryngologist and we highly recommend him.

Poojha Shri

15:49 06 Feb 23

This is Vanamadevi patient of Dr.Rayappa. Dr sir is a God in the form of human. Highly blessed to be treated by him.Gave us hope in a hopeless situation. Very good service by the whole team. Thank you.

Rajiya Sultana

08:47 06 Jan 23

I am very much satisfied in your treatment. Dr.Rayappa sir is a very kind hearted man and a great doctors ever seen in my life.May Allah bless him and his family.

Cancer of Nasopharynx

Subcranial Approach

The Heart Of Clinic

Dr. C. Rayappa MBBS, DLO, FRCS(Edin)

+91 44 3315 1105

For Doctors

Need more information?

The Heart Of Clinic

Dr. C. Rayappa MBBS, DLO, FRCS(Edin)

+91 44 3315 1105

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