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

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
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.

scholarly journals NASOPHARYNGEAL ANGIOFIBROMA

2015 ◽  
Vol 22 (08) ◽  
pp. 1053-1057
Author(s):  
Raza Muhammad ◽  
Altaf Hussain ◽  
Akhtar Zaman ◽  
Fazal Rehman ◽  
Zakir Khan
Keyword(s):  
Residual Disease ◽  
Neck Surgery ◽  
Disease Recurrence ◽  
Stage Iii ◽  
Surgical Approaches ◽  
Nasopharyngeal Angiofibroma ◽  
Neck Tumors ◽  
Stage Ivb ◽  
One Year ◽  
Study Setting

Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon tumor constitutingless than 1% of all head & neck tumors. Tumor has an aggressive local behavior if left untreated.Surgery is the mainstay of treatment with no common consensus on a single approach. Tumourstage and surgical approaches are the major determinants of tumour recurrence. Objectives:To evaluate the influence of stage of tumor in recurrence in nasopharyngeal angiofibroma.Study Design: Descriptive study. Setting: Department of ENT and Head and Neck Surgery,PIMS, Islamabad and Ayub medical institution, Abbottabad. Period: Jan 2010 to Jan 2014.Materials and Methods: Consisting of 34 diagnosed cases of nasopharyngeal angiofibroma.CT-scan was done in all patients and were treated surgically except one patient who wasirradiated. All patients were followed up for one year. Results: Among 34 patients, 24 patientswere classified as stage III, 4 were in stage II and 5 were in stage IVa and one in stage IVb. 17.6%(6/34) of patients had disease recurrence. Stage IVb was treated by radiotherapy while the restwere treated surgically. Patients were followed up for one year both by clinical examinationand imaging. Recurrence was found in 5 operated patients and residual disease in stage IVb. 1 (20%) patient of stage Iva disease and 4 (16%) patients of stage III disease had diseaserecurrence. Conclusion: Disease recurrence/ residual is directly related to the tumour stage innasopharyngeal angiofibroma.

Surgical approaches to juvenile nasopharyngeal angiofibroma

2006 ◽  
Vol 34 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Harun Cansiz ◽  
M. Güven Güvenç ◽  
Nihat Şekercİoğlu
Keyword(s):  
Juvenile Nasopharyngeal Angiofibroma ◽  
Surgical Approaches ◽  
Nasopharyngeal Angiofibroma

Juvenile nasopharyngeal angiofibroma stages I and II: A comparative study of surgical approaches

2008 ◽  
Vol 72 (6) ◽  
pp. 793-800 ◽  
Author(s):  
Ioannis Yiotakis ◽  
Anna Eleftheriadou ◽  
Dimitrios Davilis ◽  
Evagelos Giotakis ◽  
Eliza Ferekidou ◽  
...  
Keyword(s):  
Comparative Study ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Surgical Approaches ◽  
Nasopharyngeal Angiofibroma

Juvenile Nasopharyngeal Angiofibroma: A Retrospective Institutional Surgical Case Series

2020 ◽  
Author(s):  
Salomon Cohen-Cohen ◽  
Michael J. Link ◽  
Jeffrey R. Janus ◽  
Garret W. Choby ◽  
Eric J. Moore ◽  
...  
Keyword(s):  
Case Series ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Nasopharyngeal Angiofibroma ◽  
Surgical Case

Loss of Reflex Tearing: An Expected Consequence of Juvenile Nasopharyngeal Angiofibroma

2005 ◽  
Vol 133 (4) ◽  
pp. 605-610 ◽  
Author(s):  
Alexander T. Hillel ◽  
Rebecca C. Metzinger ◽  
Andrew J. Nemechek ◽  
Daniel W. Nuss
Keyword(s):  
Surgical Treatment ◽  
Hospital Setting ◽  
Case Series ◽  
Surgical Excision ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Retrospective Case ◽  
Nasopharyngeal Angiofibroma ◽  
Complete Surgical Excision ◽  
Major Teaching Hospital ◽  
Pterygopalatine Ganglion

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.

scholarly journals Juvenile Nasopharyngeal Angiofibroma: Changing Paradigms in Management

2018 ◽  
Vol 26 (1) ◽  
pp. 35-42
Author(s):  
Vijay Bhalla ◽  
Ramakrishnan Narayanaswamy
Keyword(s):  
Blood Loss ◽  
Staging System ◽  
Vascular Tumor ◽  
Demographic Variables ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Military Hospital ◽  
Endoscopic Endonasal ◽  
Nasopharyngeal Angiofibroma ◽  
Camera Systems ◽  
Endoscopic Methods

Introduction Juvenile Nasopharyngeal Angiofibroma (JNA) is a tumor of young and adolescent males. It is a benign vascular tumor arising from the spheno-palatine foramen. It is best managed surgically at present by endoscopic methods with or without pre-operative embolization. Tumor attributes like intracranial extent and residual vascularity after embolization need to be assessed pre-operatively before undertaking endoscopic surgery, in order to reduce surgical blood loss and morbidity. Materials and Methods Twenty-three cases of JNA (n=23) were operated endoscopically at a tertiary level military hospital. They were staged with the Snyderman staging system. Demographic variables including stage wise management were brought out with intraoperative time and blood loss recorded for different stages. Results                                                The intraoperative surgical time, intra-operative blood loss and recurrence/residual rates were compared with similar studies in existing literature and correlated well. Conclusion Endoscopic Endonasal approach to JNA is now a well-established technique. With improvements in embolization techniques and better instrumentation like HD camera systems, endo-bipolar cautery, Coblation and endo-liga clips and neuro-navigation, better visualization and better haemostatis can be achieved, resulting in significant reduction in the morbidity and improvement in surgical results.  

scholarly journals Trend analysis in management of juvenile nasopheryngeal angiofibroma: our institutional experience

2019 ◽  
Vol 6 (1) ◽  
pp. 94
Author(s):  
Heli H. Vasani ◽  
Chinmayee P. Joshi ◽  
Kalpesh B. Patel
Keyword(s):  
Surgical Excision ◽  
Vascular Tumor ◽  
Endoscopic Approach ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Surgical Approaches ◽  
Open Approach ◽  
Nasopharyngeal Angiofibroma ◽  
Endoscopic Method ◽  
Group A ◽  
Group B

<p class="abstract"><strong>Background:</strong> Juvenile nasopharyngeal angiofibroma is a vascular malformation rather than true neoplasm. It accounts for 0.5% of all head and neck tumors and its general incidence is 1:150,000. It is uncommon, benign, extremely vascular tumor that arises from tissues in the sphenopalatine foramen, the pterygoid base causing Early spread submucosally towards nasopharynx. Surgical excision is mainstay of treatment.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective observational study carried out from March 2002 to March 2019, 130 patients underwent surgical resection of juvenile nasopharyngeal angiofibroma at Civil Hospital, Ahmedabad. Patients were divided in two groups with Group-A having patients from 2002-2010 and Group B having patients from 2011-2019.</p><p class="abstract"><strong>Results:</strong> A total 130 cases of juvenile nasopharyngeal angiofibroma with a mean age of 16.25 years (range 9-33) were treated by surgical excision from March 2002 to March 2019. In Group A patients open approach was used most often with endoscopic approach used only till stage II-A. In Group B patients the preferred surgical approach was trans-nasal endoscopic approach cases up to stage IV-A and open approach including the midfacial degloving approach and infratemporal approach was used cases with extensive intracranial, lateral infratemporal fossa, orbit, optic nerve, cavernous sinus involvement.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows that over the years there has been shift in surgical approaches used in treating angiofibroma with the advent of newer endoscopic method and addition of various technology such as coblation, navigation has made the procedure for a highly vascular tumor simpler.</p><p class="abstract"> </p>

scholarly journals Endoscopic approach to juvenile nasopharyngeal angiofibroma: our experience at a tertiary care centre

2008 ◽  
Vol 122 (11) ◽  
pp. 1185-1189 ◽  
Author(s):  
A K Gupta ◽  
M G Rajiniganth ◽  
A K Gupta
Keyword(s):  
Tertiary Care ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Endoscopic Endonasal ◽  
Nasopharyngeal Angiofibroma ◽  
Recurrent Tumour ◽  
Residual Lesion ◽  
Operative Endoscopy

AbstractObjective:To evaluate the efficacy of endoscopic exposure and excision for juvenile nasopharyngeal angiofibroma.Design:Prospective analysis of the outcomes of endoscopic removal of the angiofibroma at a tertiary care centre, using endoscopic and radiological parameters.Subjects:Twenty-eight consecutive patients with angiofibroma were included. These patients underwent endonasal endoscopic excision of the lesion, following pre-operative computed tomography and digital subtraction angiography. Post-operative endoscopy and radiology were performed at six weeks to detect any residual lesion, and thereafter at six-monthly intervals to detect recurrence.Results:Twenty-one patients (75 per cent) were new cases and seven patients (25 per cent) had recurrent tumour. Pre-operative embolisation was performed in 21 patients (75 per cent). An endoscopic endonasal approach was used to access the pterygopalatine fossa. The average blood loss was 228 ml. Residual lesion was noted in one patient (initially with recurrent stage II C pathology). The remaining 27 patients (initially with stage I, II A and II B pathology) were free of residual pathology or recurrence after a minimum follow-up period of 12 months.Conclusion:Endoscopic exposure and excision of angiofibroma was found to be effective.

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