Association between vascular supply, stage and tumour size of juvenile nasopharyngeal angiofibroma

Objectives: To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. Methods: The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. Results: A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Conclusions: Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.

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In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma

The Journal of Laryngology & Otology ◽

10.1017/s0022215116000773 ◽

2016 ◽

Vol 130 (5) ◽

pp. 462-473 ◽

Cited By ~ 7

Author(s):

A Mishra ◽

S C Mishra ◽

V Verma ◽

H P Singh ◽

S Kumar ◽

...

Keyword(s):

Residual Disease ◽

Tumour Size ◽

Infratemporal Fossa ◽

Pterygopalatine Fossa ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Atrophic Rhinitis ◽

Complete Excision ◽

Nasopharyngeal Angiofibroma ◽

Transpalatal Approach ◽

Sublabial Approach

AbstractBackground:Juvenile nasopharyngeal angiofibroma often presents with lateral extensions. In countries with limited resources, selection of a cost-effective and least morbid surgical approach for complete excision is challenging.Methods:Sixty-three patients with juvenile nasopharyngeal angiofibroma, with lateral extensions, underwent transpalatal, transpalatal-circumaxillary (transpterygopalatine) or transpalatal-circumaxillary-sublabial approaches for resection. Clinico-radiological characteristics, tumour volume and intra-operative bleeding were recorded.Results:The transpalatal approach was suitable for extensions involving medial part of pterygopalatine fossa; transpalatal-circumaxillary for extensions involving complete pterygopalatine fossa, with or without partial infratemporal fossa; and transpalatal-circumaxillary-sublabial for extensions involving complete infratemporal fossa, even cheek or temporal fossa up to zygomatic arch. Haemorrhage was greatest with the transpalatal-circumaxillary-sublabial approach, followed by transpalatal approach and transpalatal-circumaxillary approach (1212, 950 and 777 ml respectively). Tumour size (volume) was greatest with the transpalatal-circumaxillary approach, followed by transpalatal-circumaxillary-sublabial approach and transpalatal approach (40, 34 and 29 mm3). There was recurrence in three cases and residual disease in two cases. Long-term morbidity included small palatal perforation (n = 1), trismus (n = 1) and atrophic rhinitis (n = 2).Conclusion:These modified techniques, performed with endoscopic assistance under hypotensive anaesthesia, without embolisation, offer a superior option over other open procedures with regard to morbidity and recurrences.

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Role of Transarterial Angiography with Embolization in Deciding Surgical Approach to Juvenile Nasopharyngeal Angiofibroma: A Step-Ladder Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1715594 ◽

2020 ◽

Author(s):

Ravi S. Manogaran ◽

Arulalan Mathialagan ◽

Vivek Singh ◽

Prabhaker Mishra ◽

Rajat Jain ◽

...

Keyword(s):

Surgical Approach ◽

Tertiary Care ◽

Three Dimensional ◽

Vascular Supply ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Vascular Pattern ◽

Nasopharyngeal Angiofibroma ◽

Intraoperative Bleeding ◽

Angiography And Embolization

Abstract Objectives This study was aimed to understand the usefulness of transarterial angiography and embolization in management of juvenile nasopharyngeal angiofibroma (JNA) and to apply the information obtained to stage the disease, select appropriate surgical approach, predict intraoperative bleeding, and prognosticate the disease. Design This study represents a retrospective review of the patients of JNA with major focus on transarterial angiography and embolization findings and its clinical and surgical implications. Setting The study conducted at a tertiary-care super-specialty referral center. Participants Forty-two patients who had undergone transarterial angiography and embolization followed by surgery over the period of 5 years from July 2015 till February 2019 were participated in this study. Main Outcome Measures Tumor vascular pattern based on transarterial angiography, staging of the disease based on extent and vascular supply, surgical approach selected, and prognosticating the disease were determined from this study. Conclusion Transarterial angiography with embolization becomes a prudent preoperative investigation for management of JNA. It provides a complete three-dimensional map of the tumor with stage-specific vascular pattern, reduces vascularity of the tumor, and predicts the sites from where bleeding can occur intra operatively. Thus, it helps in choosing the appropriate surgical approach aiding in complete tumor removal with minimal bleeding.

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Geometric Alopecia after Preoperative Angioembolization of Juvenile Nasopharyngeal Angiofibroma

Allergy & Rhinology ◽

10.2500/ar.2013.4.0048 ◽

2013 ◽

Vol 4 (1) ◽

pp. ar.2013.4.0048 ◽

Cited By ~ 1

Author(s):

Alejandro Vazquez ◽

Pratik A. Shukla ◽

Osamah J. Choudhry ◽

Chirag D. Gandhi ◽

James K. Liu ◽

...

Keyword(s):

Blood Loss ◽

Radiation Exposure ◽

Skull Base ◽

Vascular Supply ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Intraoperative Blood Loss ◽

Nasopharyngeal Angiofibroma ◽

Intraoperative Bleeding

Resection of a juvenile nasopharyngeal angiofibroma (JNA) is challenging because of high intraoperative blood loss secondary to the tumor's well-developed vascularity. Endoscopic sinus and skull base surgeons commonly collaborate with neurointerventionalists to embolize these tumors before resection in an attempt to reduce the vascular supply and intraoperative bleeding. However, angioembolization can be associated with significant complications. Geometric alopecia from angioembolization of JNA has not been previously reported in the otolaryngologic literature. In this study, we discuss geometric alopecia from radiation exposure during preoperative angioembolization of a JNA.

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