• PDF / 171,612 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 18 Downloads / 160 Views

DOWNLOAD

REPORT

---

1

S

Nasopharyngeal ulcer: case report A 65-year-old man developed nasopharyngeal ulcer following treatment with carboplatin and paclitaxel for an undifferentiated Epstein-Barr virus (EBV) positive carcinoma of the nasopharynx [not all routes stated]. The man, who had a history of an adenocarcinoma of the prostate, was diagnosed with an undifferentiated EBV positive carcinoma of the nasopharynx in January 2018. He received radiotherapy on the lymph nodes bilaterally along with chemotherapy comprised of IV carboplatin 2 AUC 90mg weekly and paclitaxel [Taxol] 50 mg/m2 weekly. A PET-CT scan at 3 months at the end of radiochemotherapy showed the persistence of mild hypermetabolic activity on the left side of the nasopharynx, which was considered as an inflammatory reaction secondary to the radiotherapy. Four months following the completion of the therapy, he presented with hemicranial pain and severe left-sided otalgia. The fibro-endoscopic examination of the nose revealed a large ulcer with purulent discharge on the posterior wall of the nasopharynx and mucosal necrosis. A CT scan revealed erosions of the clivus bone, which were compatible with osteitis associated with diffuse inflammation in the skull base and the retropharyngeal space. Also, a large abscess, which caused a compression of the internal carotid artery on the left side was observed. The man received treatment with piperacillin/tazobactam [Tazobac], and he underwent surgical debridement and drainage of the abscess. Bacterial biological analysis of the discharge from the fluid of the abscess revealed anaerobic germs and Staphylococcus aureus. Then, the antibiotic treatment was switched to amoxicillin/clavulanic acid [coamoxicillin] for six more weeks along with daily nasal wash using sodium chloride [saline] solution. A marked decrease in the biological parameters and inflammatory signs was noted at a follow-up at 3 weeks after surgical debridement. Two months following the conservative treatment, an MRI revealed the persistence of the deep ulcer on the posterior wall of the nasopharynx, the deep extension of the necrosis of the soft tissues and exposure of the clivus bone. Also, a threat of rupture of the internal carotid artery was detected. Therefore, he underwent surgical closure of the defect of the nasopharynx. During the procedure, the edges of the ulcer were cleaned, a fascia lata graft was taken from the region of the lateral thigh on the left side and fat grafts were harvested from the periumbilical region. A first layer of fascia lata was applied on the deep part of the ulcer and on the clivus bone, the cavity of the defect was filled by the fat grafts and a second layer was applied on the surface, which was fixed to the surrounding mucosa with the adhesive tissues. Postoperatively, he continued regular nose cleansing and antibiotic therapy. He was discharged 2 weeks following surgery, and the antibiotic therapy was switched to clindamycin for three more months. A follow-up at 4 months after surgery revealed the absence of any complications, c