Endoscopic debridement and nasoseptal flap reconstruction for managing radionecrosis of the clivus after radiation therapy for nasopharyngeal carcinoma

Abstract

INTRODUCTION: Osteoradionecrosis (ORN) of the clivus and skull base can occur after radiation therapy treatment to the skull base lesions. ORN of the skull base leads to poor quality of life and even life threatening complications like internal carotid artery aneurysms. MATERIALS AND METHODS: From 2012 -2015, 6 patients with ORN of the skull base was treated with endoscopic debridement and nasoseptal flap. All patients had previous radiotherapy for nasopharyngeal carcinoma and 4 patients had 2 courses of radiotherapy. All patients had exposed necrotic bone in the clivus/nasopharyngeal roof. All patients had foul smelling nasal discharge. 4 patients suffered from severe headache. RESULTS: 1 patient had complete loss of the nasoseptal flap and had persistent exposed bone 6 months after the procedure. 2 patients had partial loss of the distal part of the flap and 1 patient later had complete epithelization of the nasopharynx 8 months after the procedure. 3 patients had complete epithelization of the nasopharynx and no recurrence of the granulation tissue after the procedure. CONCLUSION: Endoscopic debridement and nasoseptal flap coverage is a feasible option to treat ORN of the clivus and should be the first line operation when conservative treatment fails.