Juvenile Nasopharyngeal Angiofibroma: A Retrospective Institutional Surgical Case Series

OBJECTIVE: To report the loss of reflex tearing after surgical treatment of juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN AND SETTING: A retrospective case series of 8 patients with surgical extirpation of JNA from 1995 to 2003 in a major teaching hospital setting was studied for symptomatic xerophthalmia. RESULTS: One patient was lost to follow-up. Four of the remaining 7 patients reported a dry ipsilateral eye after surgical treatment of JNA. CONCLUSION: The location of the pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa is directly adjacent to the location of origin of JNA. Lacrimal innervation passes through the pterygopalatine ganglion. Given the extensive nature of advanced JNA and mandate for complete surgical excision, lacrimal dysfunction should be considered an expected consequence of surgery. SIGNIFICANCE: The loss of reflex tearing has not been reported as a consequence of JNA or its surgical treatment. EBM Rating: C.

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Endoscopic Excision of Juvenile Nasopharyngeal Angiofibroma: Case Series of 20 Patients

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2020.v28i1.177 ◽

2020 ◽

Vol 28 (1) ◽

pp. 76-79

Author(s):

Monil Parsana ◽

Kalpesh Patel ◽

Abhishek Gugliani

Keyword(s):

Case Series ◽

Endoscopic Approach ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Recurrence Rates ◽

Nasopharyngeal Angiofibroma ◽

Young Males ◽

Medical College ◽

Recurrent Epistaxis ◽

Life Threatening ◽

Local Examination

Introduction Juvenile Nasopharyngeal Angiofibroma (JNA) is a highly vascular, benign, locally aggressive tumour of the nasopharynx. Endoscopic approach is the current accepted modality for the excision of Juvenile Nasopharyngeal Angiofibroma. The current study was undertaken to assess the outcome of this procedure at our institute. Materials and Methods A total of 20 patients of JNA at a medical college in Ahmedabad between the period of July 2015 to July 2017 were included. The tumour was staged according to Fisch system and clinical presentation, local examination, nasal endoscopy findings, radiological findings, approach of surgical resection, complications and recurrence were noted. Results We found that endoscopic approach for the excision of juvenile nasopharyngeal angiofibroma is safe and effective technique associated with reduced post operative morbidity and low recurrence rates. Conclusions JNA is a rare but a potentially life-threatening disease. All young males presenting with profuse, spontaneous and recurrent epistaxis should be evaluated for JNA. Endoscopic approaches have become the procedure of choice for resection of these tumours.

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Endoscopic excision of juvenile nasopharyngeal angiofibroma: A case series

Egyptian Journal of Ear Nose Throat and Allied Sciences ◽

10.1016/j.ejenta.2016.12.007 ◽

2017 ◽

Vol 18 (2) ◽

pp. 173-176

Author(s):

L.Y. Lim ◽

Irfan Mohamad ◽

I.P. Tang

Keyword(s):

Case Series ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Nasopharyngeal Angiofibroma ◽

Endoscopic Excision

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Patterns of vascularization and surgical morbidity in juvenile nasopharyngeal angiofibroma: A case series, systematic review, and meta-analysis

Head & Neck ◽

10.1002/hed.24987 ◽

2017 ◽

Vol 40 (2) ◽

pp. 428-443 ◽

Cited By ~ 10

Author(s):

Jonathan B. Overdevest ◽

Matthew R. Amans ◽

Peter Zaki ◽

Steven D. Pletcher ◽

Ivan H. El-Sayed

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Case Series ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Surgical Morbidity ◽

Nasopharyngeal Angiofibroma

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Multiport Combined Endoscopic Approach to Nonembolized Juvenile Nasopharyngeal Angiofibroma with Parapharyngeal Extension: An Emerging Concept

International Journal of Otolaryngology ◽

10.1155/2016/4203160 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Tiruchy Narayanan Janakiram ◽

Shilpee Bhatia Sharma ◽

Vijayshree Nahata Gattani

Keyword(s):

Parapharyngeal Space ◽

Case Series ◽

Residual Tumor ◽

Disease Recurrence ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Surgical Approaches ◽

Transoral Surgery ◽

Endoscopic Endonasal ◽

Nasopharyngeal Angiofibroma ◽

One Year

Background. Surgical approaches to the parapharyngeal space (PPS) are challenging by virtue of deep location and neurovascular content. Juvenile Nasopharyngeal Angiofibroma (JNA) is a formidable hypervascular tumor that involves multiple compartments with increase in size. In tumors with extension to parapharyngeal space, the endonasal approach was observed to be inadequate. Combined Endoscopic Endonasal Approaches and Endoscopic Transoral Surgery (EEA-ETOS) approach has provided a customized alternative of multicorridor approach to access JNA for its safe and efficient resection.Methods. The study demonstrates a case series of patients of JNA with prestyloid parapharyngeal space extension operated by endoscopic endonasal and endoscopic transoral approach for tumor excision.Results. The multiport EEA-ETOS approach was used to provide wide exposure to access JNA in parapharyngeal space. No major complications were observed. No conversion to external approach was required. Postoperative morbidity was low and postoperative scans showed no residual tumor. A one-year follow-up was maintained and there was no evidence of disease recurrence.Conclusion. Although preliminary, our experience demonstrates safety and efficacy of multiport approach in providing access to multiple compartments, facilitating total excision of JNA in selected cases.

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Juvenile Nasopharyngeal Angiofibroma

Otolaryngology ◽

10.1177/0194599812454394 ◽

2012 ◽

Vol 147 (5) ◽

pp. 958-963 ◽

Cited By ~ 21

Author(s):

Tam Cloutier ◽

Yoann Pons ◽

Jean-Philippe Blancal ◽

Elisabeth Sauvaget ◽

Romain Kania ◽

...

Keyword(s):

Residual Disease ◽

Tertiary Care ◽

Case Series ◽

Endoscopic Approach ◽

University Hospital ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Intracranial Extension ◽

Nasopharyngeal Angiofibroma ◽

Group 2 ◽

Group 1

Objective The aim of this study was to review recent management of juvenile nasopharyngeal angiofibroma (JNA) in our institution during the past 10 years and to analyze the shift in surgical paradigm based on the rate of endoscopic approach and Radkowski staging. Study Design Case series with chart review. Setting The study was conducted from April 2000 to August 2010 in a tertiary care university hospital (Lariboisière, Paris, France). Subjects and Methods All patients referred for a JNA were included in the study. Medical files and imaging data were retrospectively analyzed. Surgical management was then evaluated for 2 different periods (group 1, n = 31, consecutive patients operated on from April 2000 to June 2005, and group 2, n = 41, from July 2005 to August 2010). Results Seventy-two patients were operated on, with a mean age of 16.25 years (range, 9-33 years). The rate of the endoscopic approach was significantly higher in group 2 than in group 1 (82.9% vs 45%). Rates of recurrence and complications were similar. Recurrences (ie, residual disease growing and treated by redo) were noted in 6 cases or 8.3% (group 1, n = 3; group 2, n = 3; P > .05). Conclusion Progress in skull base anatomy, instrumentation, cameras, and surgical strategy allows for expansion of the indications for endoscopic removal of JNA. This approach may have a better outcome in terms of blood loss, hospital stay, and local sequelae. Still, an external approach should be considered only for selected cases due to massive intracranial extension or optic nerve or internal carotid artery entrapment by the tumor.

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Endoscopic Excision of Juvenile Nasopharyngeal Angiofibroma: A Case Series

Journal of Otolaryngology Research ◽

10.18875/2638-3616.1.101 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Raji A ◽

Dbab L ◽

Ait el abdia R ◽

Rochdi Y ◽

Nouri H ◽

...

Keyword(s):

Case Series ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Nasopharyngeal Angiofibroma ◽

Endoscopic Excision

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Juvenile nasopharyngeal angiofibroma – literature review and case series

Romanian Journal of Rhinology ◽

10.2478/rjr-2018-0002 ◽

2018 ◽

Vol 8 (29) ◽

pp. 17-24

Author(s):

Alexis Vuzitas ◽

Claudiu Manea

Keyword(s):

Literature Review ◽

Infratemporal Fossa ◽

Case Series ◽

Growth Patterns ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Intracranial Extension ◽

Nasopharyngeal Angiofibroma ◽

Sphenopalatine Foramen ◽

Vascular Origin ◽

Rare Benign Tumour

Abstract Juvenile nasopharyngeal angiofibroma is a rare benign tumour of vascular origin found in adolescent males, originating around the sphenopalatine foramen. Although the exact pathogenesis of the tumour is not yet known, natural history and growth patterns can be predicted. JNA progressively involves the nasopharynx, nasal cavity, paranasal sinuses, pterygopalatine fossa, infratemporal fossa and, in severe cases, an orbital or intracranial extension can be seen. Early diagnosis based on clinical examination and imaging is mandatory to ensure the best resectability of the tumour, as small to moderate tumours can be managed exclusively endoscopically. Preoperative angiography can reveal the vascular sources and allow embolization to prevent significant bleeding. We present a brief literature review followed by our case series of endoscopic removal of 7 juvenile nasopharyngeal angiofibromas.

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