2010-5-13
1. Primary Nasopharyngeal Cancer Resection Surgery
(1) Indications:
① Highly differentiated nasopharyngeal cancers, such as adenocarcinoma, squamous cell carcinoma grades I and II, and early-stage cases of malignant mixed tumors.
② Local recurrent lesions in the nasopharynx after radiotherapy are confined to the posterior or anterior roof of the nasopharynx, or involve only the edges of the pharyngeal recesses without infiltrating other areas, and patients who do not experience difficulty opening their mouths and remain in generally good physical condition.
③ For patients who have received a curative dose of radiation therapy but still show no complete resolution of the primary nasopharyngeal lesion or exhibit resistance to radiation, surgical removal can be considered after a one-month rest period.
(2) Contraindications:
① Patients with skull base bone destruction, parapharyngeal infiltration causing cranial nerve damage, or distant metastasis.
② Individuals with impaired liver and kidney function, or those in generally poor health.
(3) Surgical Procedure: Begin with a tracheostomy and endotracheal intubation. Under general anesthesia, make a horseshoe-shaped incision along the inner side of the maxillary alveolar ridge, 0.5 cm away from the tooth sockets. Subsequently, carefully dissect the hard palate mucosa beneath the surface down to the soft palate region. Remove a portion of the hard palate bone plate and the vomer. At the junction between the hard and soft palates, horizontally incise the nasopharyngeal mucosa to fully expose the anterior lateral walls and roof of the nasopharynx, including the tumor. Next, carefully cut through the posterior edge of the nasal septum and the superior border of the posterior nasal aperture, gently separating the tissue down to the underlying bone. Finally, continue the dissection along the lateral-ventral border of the nasopharynx until it meets the posterior wall of both the oropharynx and nasopharynx. Using either blunt or sharp techniques, carefully excise the entire posterior roof and lateral walls of the nasopharynx, removing the tumor en bloc along with the affected nasopharyngeal mucosa.
 
2. Neck Lymph Node Dissection
(1) Indications: After the primary nasopharyngeal cancer lesion has been controlled by radiotherapy or chemotherapy and the patient is in good general condition, with only localized residual or recurrent lesions remaining in the neck that are still mobile, neck lymph node dissection may be considered.
(2) Contraindications:
① Residual or recurrent lesions in the neck that are adhered and fixed to deep cervical tissues;
② Those with distant metastasis or extensive skin infiltration;
③ Elderly, frail individuals with uncorrected heart, lung, liver, and kidney dysfunction
(3) Excision Range: The procedure involves removing tissue extending from the mastoid tip and the inferior border of the temporal bone superiorly, down to the superior border of the clavicle. Medially, it begins at the midline of the neck, while laterally it reaches the anterior border of the trapezius muscle. Within this region, lymph nodes and fatty connective tissues are excised en bloc, along with significant portions of the platysma muscle, sternocleidomastoid muscle, internal and external jugular veins, omohyoid muscle, submandibular gland, lower pole of the parotid gland, and accessory nerve.
 
3. Simple Excision of Cervical Lymph Nodes
For solitary cervical lymph nodes that are insensitive to radiation therapy, or for patients who experience isolated cervical lymph node recurrence after radiotherapy, a simple surgical excision may be performed. After local infiltrative anesthesia, the skin and subcutaneous tissue overlying the metastatic lesion are incised, and the entire metastatic focus—including a margin of surrounding healthy tissue—is carefully removed. Following surgery, the wound can be gently compressed and appropriately bandaged.
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