Lateral Rhinotomy and Medial

Maxillectomy Approach
This approach can be used for tumors slightly larger than those
indicated for the endoscopic approach.
It may be used for recurrent or residual tumors limited to the
nasopharynx or for those with extension to the pterygopalatine
fossa.
It may also be combined with a transoral approach to resect
tumors with oropharyngeal extension.

Alternatively, it may be extended for tumors that invade the orbit.

After completion of the lateral rhinotomy, the medial wall of the
maxilla is removed as far out laterally as possible while
FIGURE 96-8. Lateral rhinotomy approach with
preserving the infraorbital nerve.
resection of medial maxilla and posterior nasal septum
completed to expose the entire nasopharynx.
The nasolacrimal duct is marsupialized, and resection of the inferior half of the middle turbinate will also
help with surgical access.
The key to visualizing the entire nasopharynx well is resection of the posterior nasal septum

The surgical access is adequate but not as wide as the view afforded by the maxillary swing approach, and it
does not require any palatal split.
The wound almost always heals well, and cosmetically it is often not an issue with the patient.

Trismus is uncommon, and palatal fistula does not occur. However, postoperatively these patients often
complain of headaches, which usually take about a month to settle; the problem is the prolonged period of
nasal clearance required to rid the crusts that develop. In addition, exposed bone may lead to localized
osteoradionecrosis.
The Maxillary Swing
The maxillary swing is an elegant operation,
described by Wei and colleagues in 1991.
It provides a wide access for resecting NP tumors.

The procedure involves a Weber-Ferguson incision.

The maxilla is exposed, and osteotomies are made

such that the maxilla will be rotated laterally; the skin
and subcutaneous tissues continue to provide the blood
supply to the maxilla, because it is not dissected off the
anterior wall of the bone FIGURE 96-9. Left maxillary swing approach. The
skin, subcutaneous tissue, left maxilla, and hard palate
The medial maxillary wall is removed. .
are rotated laterally en bloc to expose the nasopharynx
This is an approach that provides excellent access to remove tumors that have infiltrated the
pterygopalatine space.
The internal carotid artery may be controlled, should there be tumor extension laterally.

Commonly it does require a palatal split, and this can lead to palatal fistulae, although recent
modifications have been described to avert palatal splits.
The resected area allows for a vascularized free flap to be inserted to hasten healing and protect
the exposed internal carotid artery.
Chan and Wei82 reported their vast experience on nasopharyngectomy using this approach, which
is arguably the most commonly used approach for resecting recurrent NPC
Other Surgical Approaches.
◦ Lateral infratemporal and Le Fort 1 drop-down approaches have been described.
◦ These are not common approaches used to perform nasopharyngectomy for recurrent NPC and are used
by surgeons familiar and comfortable with the respective surgical approaches.