14 Nasopharynx Cancer

Nasopharynx Cancer

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THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 10/09/2019

Figure 15. Transpalatal flap approach for nasopharyngeal brachytherapy. AU-shaped incision of the palate is performed with preservation of the greater palatine vessels bilaterally. The sutures on the palate flap help provide the retraction for direct visualization of the nasopharynx. The tongue is retracted with a Dingman mouth gag. A trocar would then be inserted for permanent implantation into the nasopharyngeal tumor. [Han, et al, in Devlin, 2007]

Figure 16. Transnasal permanent interstitial seed implantation. A, tongue depressor; B, nasopharyngoscope; C, palate retractor; D. Implant needles; E, Implantation gun. Orotracheal tube employed for general anesthesia not shown. [Vikram, 1984]

Figure 17. Endoscopy-guided interstitial brachytherapy. A, The instruments and applicators used in the procedure: nasal endoscopes, fixator buttons, interstitial sharp plastic needles, plastic needles obturators, needle holder, needle and suture; B, The nasal outward view of applicators sewed to the nose wings.; C, CT scan acquisition with the applicator and dummy sources in-situ. D, Axial CT image of the residual tumor, interstitial needle and isodose line. The red arrow indicates the 100% isodose curve covering the whole GTV. E, The 3D reconstruction image of two needles encompassing the residual tumor (outlined by red fine grid lines) in coronal section. F, Treatment delivery by afterloading system. [Wan, 2014]

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