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J Neurol Surg B Skull Base 2018; 79(05): 466-474
DOI: 10.1055/s-0037-1617432
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Volumetric Analysis of Endoscopic and Maxillary Swing Surgical Approaches for Nasopharyngectomy

Nidal Muhanna
1   TECHNA Institute, University Health Network, Toronto, Ontario, Canada
2   Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
3   Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
Harley Chan
1   TECHNA Institute, University Health Network, Toronto, Ontario, Canada
,
Jimmy Qiu
1   TECHNA Institute, University Health Network, Toronto, Ontario, Canada
,
Michael Daly
1   TECHNA Institute, University Health Network, Toronto, Ontario, Canada
,
Tahsin Khan
1   TECHNA Institute, University Health Network, Toronto, Ontario, Canada
,
Francesco Doglietto
4   Department of Neurosurgery, University of Brescia, Owensboro, Kentucky 42301, United States
,
Walter Kucharczyk
1   TECHNA Institute, University Health Network, Toronto, Ontario, Canada
5   Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
,
David P. Goldstein
2   Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
3   Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
Jonathan C. Irish
1   TECHNA Institute, University Health Network, Toronto, Ontario, Canada
2   Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
3   Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
John R. de Almeida
1   TECHNA Institute, University Health Network, Toronto, Ontario, Canada
2   Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
3   Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

14 October 2016

10 November 2017

Publication Date:
19 January 2018 (online)

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Abstract

Objectives/Hypothesis The endoscopic endonasal approach (EEA) for nasopharyngectomy is an alternative to the maxillary swing approach (MSA) for selected recurrent nasopharyngeal carcinomas (NPC). We compare the access between these approaches.

Methods Three cadaver specimens were used to compare access volumes of the EEA and MSA. Exposure volumes were calculated using image guidance registration to cone beam computed tomography and tracking of accessible tissue with volumetric quantification. The area of exposure to the carotid artery was measured.

Results The MSA provided higher volumes for access volume compared with the EEA (66.6 vs 39.1 cm3, p = 0.009). The working area was larger in the MSA (80.2 vs 56.9 cm2, p = 0.06). The exposure to the carotid artery was higher in the MSA (1.88 vs 1.62 cm2, p = 0.04). The MSA provided larger volume of exposure for tumors of the parapharyngeal space with exposure below the palate.

Conclusions This study suggests that the MSA for nasopharyngectomy provides a larger volume of exposure. However, much of the increased exposure relates to exposure of the parapharyngeal space below the palate. The EEA provides adequate access to superior anatomical structures.

Keywords

endoscopic - maxillary swing - exposure volume - image guidance - nasopharyngectomy
 

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