title: Combined transcervical and orbitozygomatic approach for the removal of a nasopharyngeal adenocarcinoma.
abstract: OBJECTIVE
  In some cases, the exposure and safeguarding of the internal carotid artery (ICA) are not easy by the maxillary swing approach that is used as a mainstay for the removal of nasopharyngeal tumors. To address this issue, we have developed a new combined transcervical and orbitozygomatic approach.
  
  
  METHODS
  A nasopharyngeal adenocarcinoma arose in a 52-year-old patient and occupied the right middle skull base extending to the ICA. We first identified and dissected the ICA from the posterolateral part of the tumor using a transcervical approach. Then, the tumor was approached and removed by an orbitozygomatic technique with hemifacial dismasking. The surgical defect was filled using a temporal muscle flap, which was divided into two parts according to the blood supply from either the anterior or the posterior deep temporal artery.
  
  
  RESULTS
  The postoperative course was uneventful and favorable cosmetic results were obtained. The patient has been free of carcinoma for more than 40 months after the surgery.
  
  
  CONCLUSIONS
  Our new combined approach might be a good option for selected patients with nasopharyngeal tumors.
authors.affiliation: Department of Head and Neck Surgery, National Kyushu Cancer Center, 3-1-1, Notame, Minamiku, Fukuoka 811-1395, Japan. Electronic address: masuda.m@nk-cc.go.jp.
authors.forename: Muneyuki
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Japanese Fukuoka Red Cross Hospital, 3-1-1, Okusu, Minamiku, Fukuoka 815-8555, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Fukushima
authors.affiliation: Department of Otorhinolaryngology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Fujimura
authors.affiliation: Department of Otorhinolaryngology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan.
authors.forename: Hideoki
authors.initials: H
authors.lastname: Uryu
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D002343:Carotid Artery, Internal; D005260:Female; D006801:Humans; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000601:surgery*; D009915:Orbit; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D019292:Skull Base Neoplasms / Q000601:surgery*; D015050:Zygoma
keywords: Hemifacial dismasking; Middle skull base; Nasopharynx; Orbitozygomatic approach; Transcervical approach