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

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. "

1 Torre LA , Bray F , Siegel RL , et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65 (2): 87- 108.
doi: 10.3322/caac.21262
2 Chua MLK , Wee JTS , Hui EP , et al. Nasopharyngeal carcinoma[J]. Lancet, 2016, 387 (10022): 1012- 1024.
doi: 10.1016/S0140-6736(15)00055-0
3 Zhao W , Lei H , Zhu XD , et al. Investigation of long-term survival outcomes and failure patterns of patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: a retrospective analysis[J]. Oncotarget, 2016, 7 (52): 86914- 86925.
doi: 10.18632/oncotarget.13564
4 Tuan JK , Ha TC , Ong WS , et al. Late toxicities after conventional radiation therapy alone for nasopharyngeal carcinoma[J]. Radiother Oncol, 2012, 104 (3): 305- 311.
doi: 10.1016/j.radonc.2011.12.028
5 陈卓, 邱前辉, 粘家斌, 等. 鼻咽癌放疗后大范围颅底骨坏死的内镜手术处理及颅底重建原则[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51 (12): 881- 886.
doi: 10.3760/cma.j.issn.1673-0860.2016.12.001
CHEN Zhuo , QIU Qianhui , NIAN Jiabin , et al. Endoscopic surgery and reconstruction for extensive osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2016, 51 (12): 881- 886.
doi: 10.3760/cma.j.issn.1673-0860.2016.12.001
6 Lee AW , Ma BB , Ng WT , et al. Management of nasopharyngeal carcinoma: current practice and future perspective[J]. J Clin Oncol, 2015, 33 (29): 3356- 3364.
doi: 10.1200/JCO.2015.60.9347
7 Setton J , Han J , Kannarunimit D , et al. Long-term patterns of relapse and survival following definitive intensity-modulated radiotherapy for non-endemic nasopharyngeal carcinoma[J]. Oral Oncol, 2016, 53: 67- 73.
doi: 10.1016/j.oraloncology.2015.11.015
8 粘家斌, 邱前辉. 鼻咽癌放疗后残留或复发不同rT分级的内镜挽救性手术特点分析[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30 (6): 459- 463.
doi: 10.13201/j.issn.1001-1781.2016.06.010
NIAN Jiabin , QIU Qianhui . Analysis of the characteristics of salvage endoscopic surgery for residual or recurrent nasopharyngeal carcinoma with different rT grading after radiotherapy[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30 (6): 459- 463.
doi: 10.13201/j.issn.1001-1781.2016.06.010
9 Gil Z , Abergel A , Leider-Trejo L , et al. A comprehensive algorithm for anterior skull base reconstruction after oncological resections[J]. Skull Base, 2007, 17 (1): 25- 37.
doi: 10.1055/s-2006-959333
[1] Yan JIANG. Recurrence of nasopharyngeal carcinoma and application of endoscopic surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 1-11.
[2] Dongping CHEN,Zhihuan YANG,Yan ZHANG,Nan FANG,Bin QI. Status of surgical treatment for recurrent nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 12-16.
[3] Qianhui QIU,Zhuo CHEN. Endoscopic surgery for the treatment of locally advanced nasopharyngeal carcinoma and serious complications after radiotherapy [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 17-20.
[4] Zhenlin WANG,Junqi LIU. Protection of the internal carotid artery during surgery for nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 21-25.
[5] Haijun LU,Ji LIU,Xiao DING. Progress in the comprehensive treatment for nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 26-30.
[6] Rui CHEN,Jieen LI. Treatment of radiation-induced carcinoma in patients with nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 31-34.
[7] Wenrui XU,Yan JIANG. Surgery Treatment for Recurrent Nasopharyngeal Carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 35-38.
[8] Quan LIU,Xicai SUN,Huapeng YU,Keqing ZHAO,Huankang ZHANG,Weidong ZHAO,Yurong GU,Houyong LI,Dehui WANG,Hongmeng YU. Types of endoscopic transnasal nasopharyngectomy for nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 39-45.
[9] Lijuan ZHAO,Yan JIANG,Longgang YU,Liang CAI,Min CHEN,Jisheng ZHANG,Zhiyuan LI,Jianbao JU,Na LI. Clinical analysis of endoscopic surgery for nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 51-56.
[10] Xiaohan SUN,Na LI. Introduction to the SEOM clinical guidelines for nasopharyngeal cancer (2017) [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 57-59.
[11] WANG Jun, XING Fenli, ZHU Ping, SUN Yaping, TANG Cuiju. Comparison of two nasal irrigation methods during radiotherapy in patients with nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 60-63.
[12] . Effects of concurrent chemotherapy and radiotherapy on the quality of life in children and adolescents with nasopharyngeal carcinoma. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(2): 55-58.
[13] LIU Ye, SUN Dianshui, YIN Jinjun, XIA Ming, XU Ying, SUN Jianhua. Vestibular function damage mechanisms in nasopharyngeal carcinoma patients after intensity-modulated radiotherapy. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(6): 14-17.
[14] WANG Yaning, GENG Bo, LI Baiyan, CUI Chaoyang, WANG Qirong. The treatment experience on osteoradionecrosis of skull base with nasopharyngeal carcinoma after radiotherapy. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(6): 42-45.
[15] WANG Junying, LI Xiaofeng. Effect of deproteinized extract of calf blood gel eye on the injury of corneal endothelial cells after nasopharyngeal carcinoma radiotherapy. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(1): 76-79.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] LIN Bin,WANGHui-ge . Functional endoscopic sinus surgery, FESS[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(6): 481 -487 .
[2] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 89 -89 .
[3] LUAN Jiangang,LIANG Chuanyu,WEN Yanjun,LI Jiong . Construction of RNAi expressing plasmid vector of pSIRENshuttle for EGFR gene silencing[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 4 -8 .
[4] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 90 -91 .
[5] LIU Da-yu,PAN Xin-liang,LEI Da-peng,ZHANG Li-qiang,LUAN Xin-yong . Surgical treatment for medial wall pyriform sinus cancer[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2007, 21(1): 8 -11 .
[6] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(2): 188 -188 .
[7] MENG Qing-guo,LU Yong-tian,FAN Xian-liang .

Association of killer cell immunoglobulin-like receptor gene polymorphisms with nasopharyngeal carcinoma

[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 196 -199 .
[8] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 200 -203 .
[9] LIU Qiang-he,LUO Xiang-lin,GENG Wan-ping,CHEN Chen,LEI Xun,LIU Fang-xian,DENG Ming . Age-related spiral ganglion neuron damages and hearing loss in senescence accelerated mice[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 215 -217 .
[10] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 227 -227 .