Split-Palate Approach for Gold Grain Implantation in Nasopharyngeal Carcinoma

Abstract

Although nasopharyngeal carcinoma is radiosensitive, local failure after external radiotherapy is not uncommon and management of persistent or recurrent disease is a therapeutic challenge. The present review reports the use of brachy-therapy in the form of gold grain (198Au) implants in the treatment of 23 patients with recurrent or persistent primary nasopharyngeal carcinoma. The split-palate approach was employed in the insertion of the gold grains. This approach allows adequate exposure of the nasopharynx and accurate positioning of the implants. Implantation was successful in 21 patients, and local tumor control was achieved in 17 patients (81%) after a median follow-up of 23 months. Palatal fistula developed in 6 patients (26%): 5 healed with conservative management, and 1 had no functional disturbance. There was no operative mortality, and morbidity of the operation was minimal.

Brachytherapy for recurrent nasopharyngeal and nasoethmoidal tumours

“…By observing the safety guidelines already discussed the radiation exposure is reduced to a safe and acceptable level. The maximal dose to the trunk and fingers of the surgeon is less than 0.015 and 0.05 cGy, respectively per implant of eight gold grains (Wei et al, 1990).…”

“…Rapid dose fall off both in time and distance from the source are important factors in successful brachytherapy. The surgeon must realize, however, that brachytherapy will not eliminate extensive disease, as its effective tumouricidal range is only 0.5 cm from the source (Wei et al, 1990), therefore clearance of all macroscopic disease is essential. The demerits of this technique are the slightly increased operating time, facilities and personnel involved.…”

Transoral endoscopic nasopharyngectomy with a flexible next-generation robotic surgical system

“…In this approach, the authors fashioned a posteriorly based palatal mucosal flap, detached the soft palate from the hard palate, and removed the palatine bone for visualization and access. When Wei et al described the approach for deploying radioactive gold grain to the nasopharynx for brachytherapy, the soft palate was split in the midline for access . The same split‐palate approach was adopted by Ozer and Waltonen in 2008 for the cadaveric experiment on robotic nasopharyngectomy .…”

Early results of robotic assisted nasopharyngectomy for recurrent nasopharyngeal carcinoma

“…The technique of robotic nasopharyngectomy has been evolving. We had prior experience in nasopharyngectomy with the maxillary swing approach and palatal split approach for radioactive gold grain implant . We started robotic nasopharyngectomy with a midline palatal split approach using a 0 o telescope for midline lesions.…”

“…We had prior experience in nasopharyngectomy with the maxillary swing approach and palatal split approach for radioactive gold grain implant. 26 We started robotic nasopharyngectomy with a midline palatal split approach using a 0 o telescope for midline lesions. To further improve the dissection in the roof of the nasopharynx, we performed the superior part of the dissections, including resection of the floor of the sphenoid with a transnasal endoscopic technique, whereas the inferior part of the dissections were performed with the robot.…”