title: Endoscopic endonasal transpterygoid nasopharyngectomy.
abstract: OBJECTIVE
  Describe our technique for endoscopic transpterygoid nasopharyngectomy and support its feasibility with our early clinical outcomes.
  
  
  METHODS
  Our endoscopic technique comprises an extended inferomedial maxillectomy, mobilization of the pterygopalatine fossa, removal of the pterygoid plates and Eustachian tube to access the posterolateral nasopharynx. Control of the parapharyngeal and petrous segments of the internal carotid artery is the keystone of the approach.
  
  
  RESULTS
  Various histopathologies were treated, including epidermoid carcinomas (n = 9), lymphoepithelioma (n = 1), adenoid cystic carcinoma (n = 5), adenocarcinoma (n = 2), mucoepidermoid carcinoma (n = 2), and sarcoma (n = 1). Negative microscopic margins were obtained in 95% (19/20) of patients. No perioperative mortality, cerebral spinal fluid (CSF) leak, meningitis, or cerebrovascular accident was encountered; however, one patient suffered an internal carotid artery (ICA) injury, without permanent sequelae. All but one patient received adjuvant therapy (external and/or stereotactic radiotherapy with or without chemotherapy). Follow-up ranged from 15 to 68 months (mean = 33). Overall survival was 45% (9/20) and local control was 65% (13/20).
  
  
  CONCLUSIONS
  Endoscopic transpterygoid nasopharyngectomy for primary and recurrent nasopharyngeal malignancies is feasible and safe in properly selected patients. Preliminary outcomes compare to that of conventional techniques. Endoscopic resections, however, are demanding; they require specialized equipment and a team versed in endoscopic oncologic surgery. Long-term follow-up and reproducibility remain undefined.
authors: Department of Otolaryngology-Head & Neck Surgery, Al Nahdha Hospital, Oman.
authors: Salma
authors: S
authors: Al-Sheibani
authors: Adam M
authors: AM
authors: Zanation
authors: Ricardo L
authors: RL
authors: Carrau
authors: Daniel M
authors: DM
authors: Prevedello
authors: Emmanuel P
authors: EP
authors: Prokopakis
authors: Nancy
authors: N
authors: McLaughlin
authors: Carl H
authors: CH
authors: Snyderman
authors: Amin B
authors: AB
authors: Kassam
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000601:surgery*; D009305:Nasopharynx / Q000473:pathology / Q000601:surgery; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009666:Nose / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome