Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma

2018 ◽  
Vol 127 (5) ◽  
pp. 344-348 ◽  
Author(s):  
Kareem O. Tawfik ◽  
Jeffrey J. Harmon ◽  
Zoe Walters ◽  
Ravi Samy ◽  
Alessandro de Alarcon ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Facial Nerve ◽  
Blood Supply ◽  
Facial Palsy ◽  
Vascular Supply ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Potential Complication ◽  
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.

scholarly journals Twenty Years of Experience in Juvenile Nasopharyngeal Angiofibroma (JNA) Preoperative Endovascular Embolization: An Effective Procedure with a Low Complications Rate

2021 ◽  
Vol 10 (17) ◽  
pp. 3926
Author(s):  
Andrea Giorgianni ◽  
Stefano Molinaro ◽  
Edoardo Agosti ◽  
Alberto Vito Terrana ◽  
Francesco Alberto Vizzari ◽  
...  
Keyword(s):  
Blood Loss ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Surgical Removal ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding.

scholarly journals The Innervation and Vascular Supply of the Antrum

1934 ◽  
Vol 27 (6) ◽  
pp. 745-751 ◽  
Author(s):  
Cecil Strong
Keyword(s):  
Carotid Artery ◽  
Prussian Blue ◽  
Blood Supply ◽  
Vascular Supply ◽  
External Carotid Artery ◽  
External Carotid ◽  
Antral Mucosa ◽  
Thermal Tests ◽  
Made In

An attempt has been made to obtain information about the condition of the pulp of teeth, immediately below the bony incision, made in the lateral antral wall in radical antrotomy, and to investigate the conditions obtaining in the vascular supply of that neighbourhood. The investigation has two parts: (1) Experimental; (2) Clinical. Experimental.—( a) Injections of specimens of the superior maxillæ were made with lipiodol, then X-rayed. These showed vascular anastomoses along the antral floor. ( b) Sections of the lateral antral wall and floor were cut and stained to show nerves and blood spaces. ( c) The external carotid artery was injected with Prussian Blue and the maxilla then removed. ( d) Transverse sections of the teeth denervated were cut and their pulps examined. Clinical.—The patients who had been submitted to operation were taken, and their teeth examined by:— ( a) Transillumination. ( b) Percussion. ( c) Thermal tests. ( d) Faradic currents. ( e) Radiography. From these investigations it appears that the teeth are denervated but not devitalized by the trauma to the lateral antral wall above their apices. Their blood-supply is still present, and probably comes through a collateral anastomosis, along the antral floor and partly through the antral mucosa.

Treatment of Large Juvenile Nasopharyngeal Angiofibroma

1992 ◽  
Vol 106 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Daniel G. Deschler ◽  
Michael J. Kaplan ◽  
Roger Boles
Keyword(s):  
Magnetic Resonance ◽  
External Carotid Artery ◽  
Magnetic Resonance Images ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
External Carotid ◽  
Nasopharyngeal Angiofibroma ◽  
Large Juvenile ◽  
Intracranial Disease ◽  
Preoperative Magnetic Resonance

The management of large juvenile nasopharyngeal angiofibromas with intracranial extension is controversial. We review our experience since 1980 with eighteen patients with juvenile nasopharyngeal angiofibroma. A diagnostic and treatment approach consisting of preoperative magnetic resonance imaging, embolization of feeding branches from the external carotid artery, and attempted complete resection was used in seven patients with intracranial disease since 1987. Serial magnetic resonance images were used for followup. Intracranial disease that was persistent or recurrent and demonstrated subsequent growth was irradiated (35 to 45 cGy). Extracranial tumor recurrences were reexcised. We advocate this approach as a safe and effective alternative to primary irradiation and its sequelae.

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

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.

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

2016 ◽  
Vol 273 (12) ◽  
pp. 4295-4303 ◽  
Author(s):  
Raghav Mehan ◽  
V. Rupa ◽  
Vijay Kumar Lukka ◽  
Munawar Ahmed ◽  
Vinu Moses ◽  
...  
Keyword(s):  
Tumour Size ◽  
Vascular Supply ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Nasopharyngeal Angiofibroma

scholarly journals Geometric Alopecia after Preoperative Angioembolization of Juvenile Nasopharyngeal Angiofibroma

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0048 ◽  
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.

scholarly journals Effects of Preoperative Embolization on Juvenile Nasopharyngeal Angiofibroma Surgical Outcomes: A Study of the Kids' Inpatient Database

2020 ◽  
Author(s):  
Jonathan S. Choi ◽  
Justin Yu ◽  
Benjamin D. Lovin ◽  
Alyssa C. Chapel ◽  
Akash J. Patel ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Surgical Outcomes ◽  
Health Care Cost ◽  
Hospital Costs ◽  
Hospital Length Of Stay ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Preoperative Embolization ◽  
Nasopharyngeal Angiofibroma ◽  
Inpatient Database ◽  
Perioperative Blood Transfusion

Abstract Objectives The aim of the study is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database. Methods The health care cost and utilization project Kids' Inpatient Database was queried for all cases of operative management of JNA between the years of 1997 and 2016. Cases were stratified based on whether the patient received PVE. A multiple linear regression was used to predict the effect of PVE on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression for PVE patients. Results A total of 473 patients who underwent JNA surgical resection in this time period were identified. The use of PVE has increased from 0% in 1997 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day (p = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, p = 0.041). Patients receiving PVE were charged an additional $35,600 (p < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing. Conclusion PVE of JNA is becoming increasingly prevalent. Embolization results in decreased hospital LOS and lower odds of needing blood transfusions. While embolization increases the cost of management, this trend should be re-evaluated as this procedure is becoming more widespread.

Sign in / Sign up

Export Citation Format

Share Document