case_images: PMC10948172_01
case_images: a Initial nasal endoscopy findings - Coarse mucosal irregularities observed throughout the nasopharynx. b Initial CT imaging findings - No tumor lesions detected in the nasopharynx. Absence of apparent cervical lymph node metastasis. c MRI findings [T1 contrast] - no evident neoplastic lesions, consistent with cervical contrast CT findings. d PET/CT findings - localized abnormal SUV max 15.6 accumulation in the nasopharynx. No indications of distant metastasis.
case_images: cro-2024-0017-0001-537898_F01.jpg
case_images: PMC10948172_01_cro-2024-0017-0001-537898_F01.jpg
case_images: F1
case_images: Upon initial assessment nasal endoscopy revealed mucosal irregularities from the posterior wall of the nasopharynx to the right and left lateral walls and canopy (Fig. 1a). CT showed no obvious neoplastic lesions in the nasopharynx (Fig. 1b). MRI was consistent with CT findings (Fig. 1c). However, PET/CT showed abnormal accumulation (SUVmax:15.6) localized in the nasopharynx, with no distant metastases (Fig. 1d).
case_images: Preoperative simulation irradiation of a single site with a 30-mm frontal diffuser does not cover the entire tumor; irradiation at four sites is necessary to encompass the entire tumor.
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case_images: PMC10948172_01_cro-2024-0017-0001-537898_F02.jpg
case_images: F2
case_images: The simulation confirmed the need for four irradiation sites with a 30 mm frontal diffuser to cover the tumor (Fig. 2).
case_images: a Postoperative day 1 nasal endoscopy findings - significant edema observed from the root of the tongue to the epiglottis. b Postoperative day 12 nasal endoscopy findings - crust formation observed, corresponding to the laser-irradiated area.
case_images: cro-2024-0017-0001-537898_F03.jpg
case_images: PMC10948172_01_cro-2024-0017-0001-537898_F03.jpg
case_images: F3
case_images: A nasal endoscopy diagnosed an airway emergency due to upper airway edema and emergency bedside tracheostomy was performed due to difficulties with oral intubation (Fig. 3a). The patient was discharged on postoperative day 12 with a tracheostomy and the retina in place, with the exception of nasopharyngeal crusting (Fig. 3b).