Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2019, Vol. 33 ›› Issue (2): 46-50.doi: 10.6040/j.issn.1673-3770.0.2019.049

• Clinical Report • Previous Articles     Next Articles

Efficacy of endoscopic surgery using two types of flaps to reconstruct the skull base after radiotherapy for nasopharyngeal carcinoma

Junxiao GAO,Qianhui QIU*()   

  1. Department of Otorhinolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong, China
  • Received:2019-01-31 Online:2019-03-20 Published:2019-03-28
  • Contact: Qianhui QIU E-mail:qiuqianhui@hotmail.com

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Abstract: Objective

To explore the clinical application of free mucosal flap and vascularized mucosal flap in skull base surgery after radiotherapy for nasopharyngeal carcinoma.

Methods

A retrospective analysis of 42 cases of patients with nasopharyngeal carcinoma, who underwent radiotherapy in the Department of Otolaryngology, Zhujiang Hospital of Southern Medical University, was performed. All patients underwent mucosal flap surgery between July and November 2018. Seventeen patients underwent reconstruction surgery using a vascularized mucosal flap, and 25 underwent reconstruction surgery using a free mucosal flap. Nine patients underwent surgery twice. The area of the free mucosal flap was 4-6 cm2, and the area of the vascularized mucosa flap was 6-20 cm2.

Results

Vascularized mucosal flaps were used in 17 patients: 12 mucosal flaps healed well (70.59%), 3 did not heal completely (17.65%), and 2 showed poor healing (11.76%). Three of these patients underwent a second surgery (17.65%). Free mucosal flaps were used in 25 patients: 13 mucosal flaps healed well (52.00%), 10 did not heal completely (40.00%), and 2 showed poor healing (8.00%). Six of these patients underwent a second surgery (24.00%). Vascularized mucosal flap was used in the second surgery in all 9 patients: in 8 of these patients, flap healing was good, whereas one patient showed poor healing. It was observed that the number of courses of radiotherapy had significant effects on the survival of mucosal flaps (P=0.007): mucosal flap healing was better in the first radiotherapy than in the second. Recurrence of nasopharyngeal carcinoma and osteoradionecrosis of the skull base after radiotherapy also had a significant effect on mucosal flap healing (P=0.017). The healing of mucosal flaps in patients with osteonecrosis was poor. Regardless of the administration of a second course of radiotherapy or occurrence of osteonecrosis, there was no significant difference in mucosal survival between the vascularized mucosal flap and free mucosal flap repair (P=0.153).

Conclusion

Mucosal flap repair is an important method for endoscopic surgery to repair skull base defects after radiotherapy for nasopharyngeal carcinoma. This procedure is not only economical and non-repulsive, but is also easy to perform. The number of radiotherapy treatments and occurrence of osteonecrosis have a significant influence on the survival of mucosal flaps. The repair method had no significant effect on the survival of the flap.

Key words: Nasopharyngeal neoplasms, Radiotherapy, Osteoradionecrosis, Reconstructive surgical procedures, operative, Mucosal flaps

CLC Number: 

  • R762

Fig.1

Condition of the mucosal flap under the microscope. A. free mucosal flap healed at level 1; B. free mucosal flap healed at level 2; C. free mucosal flap healed at level 3; D. pedicled mucosal flap healed at level 1; F. pedicled mucosal flap healed at level 2; G. pedicle mucosal flap healed at level 3. "

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