Pedicled Inferior Turbinate-Nasal Floor and Septal Mucoperiosteal Flap Resurfacing for PRNN.

Abstract

Postradiation nasopharyngeal necrosis (PRNN) is one of the most severe and famous complications after radiotherapy for nasopharyngeal carcinoma (NPC). Resurfacing with pedicle nasal floor-nasal septum muco-periosteal flap after PRNN debridement is important and effective. However, the flap is limited for recovering large lesions like the parapharyngeal space and cervical vertebra. Here, we introduced a pedicle inferior turbinate-nasal floor and septal mucoperiosteal flap (inferior turbinate-nasal flap, ITNF) for reconstruction. From November 2012 to July 2025, 71 PRNN patients with necrosis involving the parapharyngeal space or extensive skull base received endoscopic nasopharyngeal necrosis debridement followed by ITNF resurfacing were enrolled and analyzed. All surgeries were successfully performed without any severe postoperative complications or death. The 3-month complete healing and effective healing rate achieved 69.0% and 98.5%. The 1- and 2-year overall survival (OS) rate of the entire cohort reached 87.3% and 81.7%, respectively. The degree of necrosis was identified as an independent predictor of complete nasopharyngeal defect healing (OR = 19.520, 95% CI: 2.335-163.156, p = 0.006). It was also found to be an independent predictor of OS (HR = 10.443, 95% CI: 1.312-83.116, p = 0.027). The ITNF resurfacing after endoscopic debridement is a safe, effective, and promising treatment for PRNN patients.