Transorbito-maxillary percutaneous endoscopic gastrostomy

Abstract

Peroral, enteral feeding is often impossible in patients with head and neck cancer. Percutaneous endoscopic gastros¬tomy is a well-established, quick, minimally invasive, and safe procedure for providing long-term enteral feeding. Space-occupying tumour mass and altered anatomy due to surgery inhibit the gastroscope's peroral introduction and the feeding tube's placement in some instances. Various access routes and modified insertion techniques are recom¬mended to overcome the feeding tube insertion challenges. We present a rare case of a 64-year-old head and neck cancer patient who was unable to eat orally due to trismus and had a facial soft tissue defect following total maxil¬lectomy and orbital exenteration. A complete oesophago-gastro-duodenoscopy and feeding tube insertion were performed transfacially. Percutaneous endoscopic gastrostomy was successful and uneventful via the maxillary and orbital soft tissue facial defect. No complication was noted, and long-term enteral feeding of the patient was pro¬vided in a minimally invasive way. Surgeons often face challenging cases when treating patients with head and neck cancer. The modification of standard procedures is sometimes required to adapt surgical techniques to the patient's specific case.