Endoscopic Nasopharyngeal Surgery: A Minimally Invasive Approach

Introduction

The nasopharynx is the uppermost part of the pharynx, located behind the nasal cavity and above the soft palate. It plays a crucial role in respiration, phonation, and drainage of the middle ear through the Eustachian tube. Surgical access to this area was traditionally challenging due to its deep location, but endoscopic nasopharyngeal surgery now provides excellent visualization and access using the nasal cavity as a natural corridor.

Endoscopic techniques are used for biopsies, tumor resection, adenoid removal, and treatment of nasopharyngeal cysts or infections, offering a less invasive alternative to open surgery.

Indications for Endoscopic Nasopharyngeal Surgery

• Nasopharyngeal tumors (benign or malignant)

• Nasopharyngeal carcinoma (NPC) biopsy or resection

• Choanal polyps

• Adenoid hypertrophy in adults

• Eustachian tube dysfunction

• Tornwaldt cysts

• Bleeding or vascular malformations (e.g., juvenile nasopharyngeal angiofibroma)

Advantages of the Endoscopic Approach

• No external incisions or scars

• Enhanced illumination and magnified vision

• Preservation of surrounding structures

• Reduced postoperative pain and bleeding

• Shorter hospital stay and faster recovery

• Useful in pediatric and adult populations

Surgical Technique Overview

1. Anesthesia

• General anesthesia is typically used for better control and patient safety.

2. Endoscopic Access

• A 0° or 30° rigid nasal endoscope is introduced through the nostril.

• Nasal decongestants are applied to improve visualization.

3. Tissue Handling or Resection

• A biopsy punch, microdebrider, or suction cautery may be used.

• In tumor cases, margins are identified and carefully excised.

• Hemostasis is achieved with bipolar cautery or nasal packing if needed.

4. Specimen Collection and Reconstruction

• Pathological specimens are collected for histology.

• The surgical site is usually left open to heal by secondary intention.

Common Conditions Managed Endoscopically

Postoperative Care

• Saline nasal rinses to promote healing

• Analgesics for discomfort

• Avoidance of nose blowing or strenuous activity

• Antibiotics or steroids as needed

• Follow-up nasal endoscopy to monitor healing

Risks and Complications

• Bleeding

• Infection

• Injury to the Eustachian tube

• Velopharyngeal insufficiency (rare)

• Tumor recurrence in oncologic cases

Prognosis and Outcomes

Most benign conditions treated endoscopically have excellent outcomes. In oncologic surgery, early-stage nasopharyngeal tumors may be completely resected endoscopically or debulked before chemoradiotherapy. The endoscopic approach continues to grow in importance with improvements in optics and instrumentation