Endoscopic Debridement of Post-Radiation Nasopharyngeal Necrosis: The Effects of Resurfacing With a Vascularized Flap.

IF 2.9 3区 医学 Q1 OTORHINOLARYNGOLOGY
Bokhyun Song, Hyo Yeol Kim, Yong Gi Jung, Chung-Hwan Baek, Man Ki Chung, Sang Duk Hong
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引用次数: 0

Abstract

Objectives: Post-radiation nasopharyngeal necrosis (PRNN) is a serious complication that severely impacts the quality of life and survival of nasopharyngeal carcinoma patients. Endoscopic debridement is considered the first-line treatment for PRNN. This study aimed to analyze clinical outcomes, focusing on the mucosal resurfacing status and the effectiveness of salvage operations.

Methods: Twenty-seven patients who underwent endoscopic debridement were retrospectively analyzed. The patients were divided into two groups according to the initial surgical modality: debridement with a nasoseptal flap (NSF; n=21) and debridement only (no NSF; n=6). Clinical features, postoperative mucosal status, internal carotid artery (ICA) rupture, survival, and final mucosal status were evaluated. The NSF group was categorized according to flap viability to analyze risk factors for flap failure.

Results: Regardless of the initial modality, most patients experienced symptom improvement (96.0% for headache and 100% for foul odor); however, complete cranial nerve palsy did not improve in any patients. In the NSF group, complete healing was observed in 66.7%, while all patients in the no-NSF group underwent salvage surgery because none maintained complete healing. In the NSF group, 19.0% of patients required salvage surgery. After the last operation, favorable symptom improvement was noted (100% for headache and 90.0% for foul odor), and 77.8% had completely healed mucosa, whereas only 14.8% and 7.4% had partial healing and persistent necrotic mucosal status. The necrotic or uncovered NSF subgroup showed statistically non-significant tendencies for old age, advanced necrosis stage, advanced T stage, ICA involvement, high frequency and dose of radiation therapy, diabetes mellitus, and underlying comorbidities. Two ICA ruptures and three deaths occurred.

Conclusion: Resurfacing the nasopharynx with NSF after endoscopic debridement showed better outcomes than debridement only for PRNN treatment. Despite initial NSF failure, additional resurfacing reconstructive surgery offers advantages in symptom mitigation, quality of life, and survival.

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内镜下放射后鼻咽坏死清创:带血管皮瓣表面修复的效果。
目的:鼻咽癌放疗后鼻咽坏死(PRNN)是严重影响鼻咽癌患者生活质量和生存的严重并发症。内镜下清创被认为是PRNN的一线治疗方法。本研究旨在分析临床结果,重点关注粘膜表面重塑状况和挽救手术的有效性。方法:回顾性分析27例内镜清创患者的临床资料。根据初始手术方式将患者分为两组:鼻中隔瓣清创(NSF);n=21),仅清创(无NSF;n = 6)。评估临床特征、术后粘膜状态、颈内动脉(ICA)破裂、存活和最终粘膜状态。根据皮瓣活力对NSF组进行分类,分析皮瓣衰竭的危险因素。结果:无论初始治疗方式如何,大多数患者症状改善(头痛96.0%,恶臭100%);然而,完全脑神经麻痹在任何患者中都没有改善。在NSF组中,66.7%的患者完全愈合,而在无NSF组中,由于没有患者保持完全愈合,所有患者都进行了补救性手术。在NSF组中,19.0%的患者需要补救性手术。最后一次手术后,患者症状好转(头痛100%,恶臭90.0%),77.8%的患者粘膜完全愈合,14.8%和7.4%的患者粘膜部分愈合和持续坏死。坏死或未发现NSF亚组在老年、晚期坏死、晚期T期、ICA受累性、高频率和高剂量放疗、糖尿病和潜在合并症方面的趋势无统计学意义。发生了2例内卡破裂和3例死亡。结论:鼻咽内镜清创后用NSF置换鼻咽部比单纯清创治疗PRNN效果更好。尽管最初NSF失败,额外的表面重建手术在症状缓解、生活质量和生存方面具有优势。
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来源期刊
CiteScore
4.90
自引率
6.70%
发文量
49
审稿时长
6-12 weeks
期刊介绍: Clinical and Experimental Otorhinolaryngology (Clin Exp Otorhinolaryngol, CEO) is an international peer-reviewed journal on recent developments in diagnosis and treatment of otorhinolaryngology-head and neck surgery and dedicated to the advancement of patient care in ear, nose, throat, head, and neck disorders. This journal publishes original articles relating to both clinical and basic researches, reviews, and clinical trials, encompassing the whole topics of otorhinolaryngology-head and neck surgery. CEO was first issued in 2008 and this journal is published in English four times (the last day of February, May, August, and November) per year by the Korean Society of Otorhinolaryngology-Head and Neck Surgery. The Journal aims at publishing evidence-based, scientifically written articles from different disciplines of otorhinolaryngology field. The readership contains clinical/basic research into current practice in otorhinolaryngology, audiology, speech pathology, head and neck oncology, plastic and reconstructive surgery. The readers are otolaryngologists, head and neck surgeons and oncologists, audiologists, and speech pathologists.
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