Reconstructive Flaps After Salvage Nasopharyngectomy

Abstract

 Importance: The emergence of new technologies for early diagnosis of recurrent nasopharyn
geal cancer and new techniques of endoscopic nasopharyngectomy increase the incidence of 
salvage nasopharyngectomy and pose the question of the ideal flap for reconstruction of this 
defect.
 Objectives: A review of the literature to identify the flaps used in nasopharyngeal reconstruc
tion and their advantages and disadvantages, characteristics, and outcomes. 
Methods: We reviewed the literature available in the English language to identify the various 
f
 laps used, their indications and surgical technique, complications and outcomes.
 Results: Multiple flaps have been used. Local mucosal flaps such as the posterior pedicled 
middle turbinate mucoperiosteal flap, the posterior pedicled Nasal Septal Flap (NSF) and Floor 
mucoperiosteum flap (FF), pedicled flaps such as the extended glabellar fascial cutaneous flap, 
the Haddad-Bassagasteguy flap, the temporoparietal fascial flap and the pericranial flap and 
free flaps such as the radial forearm and vastus lateralis flap have been described. These flaps 
are used depending on the specific defect characteristics and tissue available for reconstruction. 
The advantages and disadvantages of these flaps are discussed.
 Conclusion: No single flap is ideal for all cases. The choice of flap will have to be tailored ac
cording to the patient, the defect created, consistent with oncologic principles, donor site avail
ability and surgeon preference. A working knowledge of available flaps is essential to provide 
coverage of the skull base to avoid vascular and infectious complications.