Open nasopharyngectomy—Facial translocation approach

Salvage nasopharyngectomy has become the mainstay of treatment after radiotherapy failure for nasopharyngeal carcinoma. However, surgical access to the nasopharynx has always been a challenge to head and neck surgeons. Various surgical approaches to the nasopharynx includes transpalatal, transmaxillary, midline mandibulotomy, transpterygoid, facial translocation, and infratemporal fossa approaches. The facial translocation approach is based on the principle of disassembling of vascularized midfacial composite units, permitting wide access for the treatment of tumors at nasopharynx, anterior skull base, paranasal sinuses, pterygomaxillary and infratemporal fossa, and the orbit. The facial translocation approach offers previously unavailable wide and direct exposure and allows extensive resection of tumors in the above areas. Facial translocation also preserves critical structures through approximation and fixation of the facial fragments after the operation, with a potential for immediate reconstruction of the complex region of the nasopharynx and cranial base.