A Case of Free Flap Reconstruction after Endoscopic Debridemnt for Recalcitrant Nasopharyngeal Osteoradionecrosis Without Facial Incision

High-dose radiation therapy is the treatment of choice for nasopharyngeal cancer, and clinical outcomes have improved in recent decades. A certain proportion of patients, however, suffer from post-radiation nasopharyngeal necrosis (PRNN). Patients with PRNN complain of headache, foul odor, or symptoms of cranial nerve palsies. Clinically, intracranial infection or bleeding from carotid artery damage may lead to sudden death or severe deterioration in quality of life. Although the prognosis of PRNN was poor, endoscopic debridement with local vascularized flap recently showed favorable outcomes, and many centers are using this technique with a nasoseptal flap. However, if the flap fails or does not fully cover necrotized tissues, necrosis inevitably reoccurs. In this situation, free flap transfer with a facial incision using a transmaxillary approach is used, but some drawbacks exist. In this report, we propose a new resurfacing technique for recurrent PRNN using a transoral-cervical free flap tunneling approach into the nasopharynx without a facial incision after endoscopic debridement.