2018 AMI Online Salon

Maxillary swing and free muscular flap for osteoradionecrosis in nasopharyngeal carcinoma

Project Details

  • Artist(s):  Junsun Ryu, Goyang-si, Gyeonggi-do
  • Client: Chung-Hwan Baek
  • Copyright: © 2018 Junsun Ryu
  • Medium / software used: Adobe CC, Corel Painter 2018
  • Final presentation format: Color print
  • Primary audience: Head and neck surgeons, fellows, medical students

Project Description

This illustration outlines an efficient management of extensive osteonecrosis in the nasopharynx after repeated radiation treatment in nasopharyngeal cancer patients. The nasopharynx is located deeply under the skullbase, behind the nasal cavity. Surgical access to the site is very difficult due to its narrow routes. Traditionally, necrosis in this area has been managed by endoscopic procedures, which are insufficient and cannot prevent to dreadful events such as carotid blowout or meningoencephalitis. In the proposed method, the facial bone is swung open like a door to give access to a wider surgical field which allows for free muscular flap coverage as well as removal of necrotic tissue. The procedure was shown to prevent further complications and had relatively small cosmetic and functional impairments. This illustration describes the locations of the skin incision and bone cuts, focusing on the relative anatomy of nasopharynx and parapharynx after the maxillary swing.