A novel combined approach: trans-nasal endoscopic and transoral robotic-assisted resection of nasopharyngeal amyloidosis.

Amyloidosis is a condition characterized by extracellular deposition of insoluble, proteinaceous material with β-pleated ultrastructure. Localized head neck amyloidosis is rare with 41 cases of nasopharyngeal amyloidosis reported. A 56-year old male, with a history of T2 N1 M0 HPV positive left tonsillar squamous cell carcinoma, under surveillance post-treatment, had an incidental finding of a nasopharyngeal amyloidosis (AL lambda), involving the right lateral wall. This was resected with combined trans-nasal and transoral robotic-assisted surgery (TORS) approach, avoiding palatal split while using suction catheter for soft palate retraction. This is the first case of nasopharyngeal amyloidosis treated with this novel technique. The patient had complete resolution of swallowing with good palatal function by 2 months post-procedure and a 1 year recurrence free survival. TORS is a great adjunct for nasopharyngeal resections where conventional methods maybe limited. The combined approach added excellent 3D visualization and precise dissection without the sequel of palatal splitting.