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Page 6 of 11 Pang et al. Mini-invasive Surg 2024;8:27 https://dx.doi.org/10.20517/2574-1225.2023.124

tissue disruption and postoperative distress, resulting in accelerated recovery durations compared to
alternative surgical procedures. However, potential complications, such as oronasal fistulas - abnormal
connections between the oral and nasal cavities - should be carefully considered, as they may require
additional treatment. The appropriateness of the hard palate approach primarily hinges upon the tumor’s
size and spatial orientation, being optimally suited for superficial tumors not extensively invading intricate
anatomical landmarks. It remains incumbent upon the surgeon to judiciously assess the individualized case,
factoring in the tumor’s unique attributes and the patient’s holistic health profile.

Pterygopalatine fossa approach
The pterygopalatine fossa approach is a surgical strategy invoked for the excision of nasopharyngeal tumors.
This approach accesses the nasopharynx via the maxillary sinus, obviating the necessity for external
incisions and offering a direct conduit for tumor excision . It exhibits particular efficacy against NPC
[37]
located within the pterygopalatine fossa. The suitability of this approach depends on the specific
characteristics and location of the tumor. Predominantly, it is tailored for neoplasms anchored within the
pterygopalatine fossa, rendering it less fitting for tumors ensconced in other nasopharyngeal sectors. A
meticulous patient assessment, along with a case-centric evaluation, is imperative to ascertain whether the
pterygopalatine fossa approach is appropriate for a given case of nasopharyngeal tumor resection.

Infratemporal fossa approach
The infratemporal fossa approach is a surgical technique devised for the resection of nasopharyngeal
tumors. This method provides access to the nasopharynx by navigating through the infratemporal fossa, a
complex anatomical region located beneath the skull base, bordered by the maxilla and temporal bone. It
allows surgeons to remove tumors affecting the ipsilateral nasopharynx. While the infratemporal fossa
approach is adept at addressing specific tumor presentations, it may be less suitable for tumors extending
into the contralateral nasopharynx. The exposure afforded by this methodology may fall short for all-
encompassing tumor resection in such scenarios, potentially engendering complications such as conductive
[38]
hearing impairment and trigeminal nerve anomalies .

Lymph node dissection
For patients with locally recurrent neck lymph node metastasis of NPC following radiotherapy, surgical
intervention becomes a viable consideration. This approach is generally considered for individuals who are
not candidates for additional radiotherapy or chemotherapy, especially when distant metastases are absent.

Historically, radical neck lymph node dissection stood as the favored approach to treat neck lymph node
recurrence in nasopharyngeal cancer. However, recent studies suggest a negligible difference in
postoperative survival and recurrence rates between selective neck lymph node dissection and its
comprehensive counterpart [39,40] . Research by Wang et al. posits that salvage neck lymph node dissection for
[41]
recurrent NPC yields a local control rate nearing 86.3% . Earlier scholarly publications estimated the
postoperative survival rate at a range of 54%-57% [41,42] . Investigations by Li et al. discerned adverse
prognostic markers, such as extranodal extension, the presence of over two pathologically positive lymph
nodes, and afflictions of the lower neck, notably at levels IV and Vb [43,44] . For patients with isolated
retropharyngeal lymph node recurrence, selective neck lymph node removal remains feasible. Chan et al.
[44]
reported a 5-year control rate of 76% and a 5-year disease-free survival rate of 59% for this approach . The
choice of the optimal surgical approach is heavily influenced by these factors. An emerging surgical frontier
is the incorporation of robot-assisted transoral retropharyngeal and parapharyngeal lymph node dissection,
hailed for its precision and potential recovery advantages .
[45]