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>

Transnasal microscopic approach for juvenile nasopharyngeal angiofibroma

2018 ◽  
Vol 72 (5) ◽  
pp. 31-36 ◽  
Author(s):  
Wiesław Gołąbek ◽  
Anna Szymańska ◽  
Kamal Morshed
Keyword(s):  
Infratemporal Fossa ◽  
Surgical Excision ◽  
Vascular Tumor ◽  
Stage I ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Preoperative Embolization ◽  
Stage Iiia ◽  
Nasopharyngeal Angiofibroma ◽  
Feeding Vessels

Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumor originating in the nasopharynx. The treatment of choice for JNA is surgical excision. In recent years, surgical management has been greatly influenced by the use of the transnasal endoscopic technique. The aim: The aim of the study was to present our experience with the transnasal microscopic removal of JNA. Material and methods: Ten patients with JNA aged 12-17 underwent diagnostics imaging and transnasal microscopic tumor excision. Medical records of patients were retrospectively reviewed. The main outcome measures were complications and recurrences. Preoperative embolization of feeding vessels was performed in 7 patients. Results: According to Andrews’ classification, the group included 2 stage I patients, 6 stage II patients and 2 stage IIIA patients with the extensive occupation of the infratemporal fossa. 9 patients had no recurrence in 6-11 years follow up. One stage IIIA patient had a recurrence posteriorly to the pterygopalatine process and it was completely removed. No complications during or after surgery occurred. Conclusion: Transnasal microscopic excision is an effective approach to resect stage I-IIIA JNA

scholarly journals Juvenile Nasopharyngeal Angiofibroma: Correlating Histology, Surgical Approach and Blood Loss

2015 ◽  
Vol 8 (2) ◽  
pp. 47-52
Author(s):  
RG Aiyer ◽  
Rahul R Gupta ◽  
Prarthna J Jagtap ◽  
Tanuj Thapar
Keyword(s):  
Blood Loss ◽  
Surgical Approach ◽  
Surgical Excision ◽  
Complete Removal ◽  
Vascular Tumor ◽  
Growth Patterns ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Treatment Modalities ◽  
Successful Outcome ◽  
Nasopharyngeal Angiofibroma

ABSTRACT Juvenile nasopharyngeal angiofibroma (JNA) is locally destructive benign vascular tumor for which surgical excision has always been the treatment of choice, in spite of the availability of various other treatment modalities. Complete removal at the maiden attempt has always been the key to a successful outcome. Recurrences (or rather residuals) discourage both the surgeon and patient. This prospective study was carried out in the Department of Otorhinolaryngology, Sir Sayajirao General Hospital, Vadodara, Gujarat, between August 2002 and 2015. We have studied 28 patients with JNA for growth patterns, histological characteristics and to compare various surgical modalities. Besides other investigations a detailed histological examination of the tumor was performed which suggested that as the tumor ages, the stroma predominates and the vessels are compressed into slits. In actively growing tumor the vascular component predominates. The percentage of open vascular channels is directly proportional to the bleeding while the intervascular fibrosis is inversely related. Surgical excision of JNA is the preferred modality of treatment. Surgical approach is sometimes the most tricky decision. Choosing the right approach is akin to walking on the thin rope with adequate exposure on one side and postoperative scar on the other. How to cite this article Thapar T, Gupta RR, Jagtap PJ, Aiyer RG. Juvenile Nasopharyngeal Angiofibroma: Correlating Histology, Surgical Approach and Blood Loss. Clin Rhinol An Int J 2015;8(2):47-52.

Juvenile Nasopharyngeal Angiofibroma: Diagnosis and Treatment

1987 ◽  
Vol 97 (6) ◽  
pp. 534-540 ◽  
Author(s):  
Arndt J. Duvall ◽  
Alex E. Moreano
Keyword(s):  
Benign Lesion ◽  
Ct Scanning ◽  
Operative Management ◽  
Vascular Tumor ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Surgical Approaches ◽  
Nasopharyngeal Angiofibroma ◽  
Primary Treatment Modality ◽  
Fatal Hemorrhage ◽  
Incomplete Removal

Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon, histologically benign vascular tumor that occurs almost exclusively in adolescent males. While occasional mention is made of the occurrence of JNA in females and in older males, only four1 cases have withstood rigorous clinicopathological review. This neoplasm accounts for less than 0.05% of all benign lesions that originate in the nasopharynx. Its clinically malignant behavior is a result of its propensity for locally destructive growth and fatal hemorrhage. The evolution in the management of these tumors has been the subject of much interest and much confusion. The advents of computed tomographic (CT) scanning, selective angiography with embolization, and refinements in surgical approaches have revolutionized operative management of these lesions by allowing more realistic selection of surgical candidates, better preoperative planning, and more flexible (yet aggressive) primary surgical treatment. The attendant reduction in morbidity and mortality of contemporary surgical management of this disease has largely obviated the argument of those who advocate use of radiotherapy as the primary treatment modality for this benign lesion. This latter view is based on the reports of massive hemorrhage, significant incidence of incomplete removal, and mortality reported in the older surgical literature. This article details our experience with a series of 31 patients who had clinicopathological diagnoses of JNA and were treated between 1954 and 1984. It furthermore represents an update of our previously reported series.2

scholarly journals Recurrence Rate after Endoscopic vs. Open Approaches for Juvenile Nasopharyngeal Angiofibroma: A Meta-analysis

2018 ◽  
Vol 80 (06) ◽  
pp. 577-585 ◽  
Author(s):  
Camilo Reyes ◽  
Heather Bentley ◽  
J. Alejandro Gelves ◽  
C. Arturo Solares ◽  
J. Kenneth Byrd
Keyword(s):  
Recurrence Rate ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Tumor Stage ◽  
Endoscopic Approach ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Disease Stage ◽  
Open Approach ◽  
Nasopharyngeal Angiofibroma ◽  
Lower Recurrence Rate

Context The effect on recurrence rate between patients with juvenile nasopharyngeal angiofibroma (JNA), treated by an endoscopic versus open approach, has not been well established. Objective A meta-analysis of the available literature concerning recurrence rate in patients who underwent surgery for JNA. Methods A retrospective meta-analysis of studies analyzing recurrence rate after endoscopic or open surgery for patients with JNA was performed using the DerSimonian–Laird random-effects method. English and non-English articles were reviewed using Embase, Medline, and Cochrane databases. Results Among nine studies, including 362 patients from 1981 to 2015, with a mean follow-up of 49.4 months, a total of 89 patients (24.5%) had recurrence. Our analysis revealed a total effect size of −0.16 in favor of endoscopic approach (−0.25 to −0.06, CI [confidence interval] 95%). When analyzing tumor by stage (Radkowski's IA–IIIB n = 299), the endoscopic approach proved to be superior independent of tumor stage (2 vs. 17% for tumors stage IA–IIA, and 26 vs. 32% for tumor stage IIB–IIIB for endoscopic and open approaches respectively; p < 0.05). The endoscopic approach has a statistical significant lower recurrence rate in patients without intracranial compromise when compared with the open approach (13 vs. 28%; p < 0.02). No statistical difference was seen in patients with intracranial compromise (p = 0.5) Conclusion The use of an endoscopic approach to treat JNA has a significantly lower recurrence rate when compared with open approaches. Independent of disease stage, an endoscopic approach should be the standard of care to surgically treat JNA. For cases with intracranial compromise, either approach can be used for surgical resection.

Successful Repair of Large Skull Base Defect Following JNA Excision

2010 ◽  
Vol 3 (1) ◽  
pp. 49-52
Author(s):  
Alok Thakar ◽  
Gaurav Gupta ◽  
Mohnish Grover
Keyword(s):  
Skull Base ◽  
Free Flap ◽  
Surgical Excision ◽  
Vascular Tumor ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Nasopharyngeal Angiofibroma ◽  
Young Males ◽  
Skull Base Defect ◽  
Successful Repair

Abstract Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular tumor of young males. Surgical excision remains the principal modality of treatment. Tumors with intracranial extension may require major surgical resections which are not devoid of complications. We here present a case of JNA with massive intracranial extension with postsurgery huge skull base defect with resultant encephalocele which was repaired successfully using rectus abdominis free flap.

scholarly journals Management and Outcome in Patients with Advanced Juvenile Nasopharyngeal Angiofibroma

2017 ◽  
Vol 79 (04) ◽  
pp. 353-360 ◽  
Author(s):  
Vedantam Rupa ◽  
Sunithi Mani ◽  
Selvamani Backianathan ◽  
Vedantam Rajshekhar
Keyword(s):  
Residual Disease ◽  
Tertiary Care ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Surgical Approaches ◽  
Open Approach ◽  
Nasopharyngeal Angiofibroma ◽  
Expanded Endonasal Approach ◽  
Lost To Follow Up ◽  
Disease Free

Objective To report the management outcome in a series of patients with advanced juvenile nasopharyngeal angiofibroma (JNA). Design Retrospective study. Setting Tertiary care teaching hospital. Participants Forty-five patients classified as Radkowski stage IIIA or IIIB who presented to us over the past 10 years. Main Outcome Measures Surgical approaches used and disease free outcomes in patients with advanced JNA. Results Surgical access for the extracranial component included open (41.9%) and expanded endonasal approaches (58.1%). Craniotomy (16.3%), endoscopy-assisted open approach (7%), or expanded endonasal approach (20.9%) was performed to excise the skull base or intracranial component. Follow up ranged from 4 to 96 months (mean, 20.3 months). Of 35 patients who underwent imaging at the first postoperative follow up, 25 (71.4%) had negative scans. Three symptomatic patients with residual disease underwent endoscopic excision and had negative scans thereafter. Of two others who had radiation therapy, one was disease free and the other lost to follow up. Five others had stable, residual disease. Three patients (8.6%) with recurrent disease underwent surgical excision, of whom two had minimal, stable residual disease. At the last follow-up, 27 (77.1%) patients had negative scans, and 7 (20%) had stable residual disease with one (2.9%) patient lost to follow-up. Conclusions Advanced JNA may be successfully treated in most cases with expanded endonasal/endoscopy assisted ± craniotomy approach after appropriate preoperative evaluation. At follow-up, only symptomatic patients or those with enlarging residue require treatment; periodic imaging surveillance is adequate for those with stable disease.

scholarly journals Out Come of Wide Local Excision with and without Corticosteroid Therapy in Management of Idiopathic Granulomatous Mastitis

2021 ◽  
Vol 107 (1_suppl) ◽  
pp. 13-13
Author(s):  
R Amira Maher ◽  
Ahmed Gamal Eldin Osman ◽  
K Fahmy ◽  
Shinamwi M ◽  
Osama Al Atarash
Keyword(s):  
Recurrence Rate ◽  
Corticosteroid Therapy ◽  
Surgical Excision ◽  
Cosmetic Outcome ◽  
Systemic Steroid ◽  
Granulomatous Mastitis ◽  
Idiopathic Granulomatous Mastitis ◽  
Palpable Mass ◽  
Group A ◽  
Group B

Introduction: Idiopathic granulomatous mastitis is a rare benign breast disease. Initial reports from hospitals in Egypt from Departments of Pathology at Cancer Institutes of Cairo, Tanta and Mansoura Universities; indicate that the disease is not as rare as that in the developed countries. It often mimics breast carcinoma both clinically and radiologically. Histological examination is the gold standard for diagnosis. Management of Idiopathic granulomatous mastitis is still debatable. In our study, we aimed to evaluate the addition of corticosteroid therapy to surgical excision in management of idiopathic granulomatous mastitis. Patients and Methods: This is a comparative study was conducted at Ain-Shams University Hospital’s breast clinic on patients with idiopathic granulomatous mastitis from to August 2015 till September 2018. Thirty patients were divided into 2 groups. Group (A) includes patients who underwent surgical management only. Group (B) includes patients who received corticosteroid therapy according to the severity of the cases then surgical Excision was done for the residual lesion. Follow up of all cases up to 1-2 years was done to document the recurrence rate and compare the cosmetic outcome of both groups. Informed consent was obtained from all patients included in the study. Results: The mean age of the affected women was 38.80 and 33.13 in group (A) and group (B), respectively and it wasn’t statistically different (p value = 0.099). The most common presenting symptom was a palpable mass in the breast (66.7% and 93.3%) in group (A) and group (B) respectively. Recurrence rate was higher in group (A) (40%) with no recurrence documented in group (B) however 2 cases were omitted from the study due to steroid noncompliance and complications. Cosmetic outcome was excellent in 76.9% of group (B) and good in 53.3% of group (A). Conclusion: Systemic steroid therapy with surgical resection is the recommended as first-line treatment strategy for IGM as it shows less recurrence rate and surgical scarring. Increased awareness of IGM will increase their understanding and improve their management.

Treatment of Canine Transmissible Venereal Tumour using Different Surgico-chemotherapeutic Protocols

2021 ◽  
Author(s):  
Nutan Punchkande ◽  
Rukmani Dewangan ◽  
Raju Sharda ◽  
D. Jolhe ◽  
Dhaleshwari Sahu ◽  
...  
Keyword(s):  
Biochemical Parameters ◽  
Histopathological Examination ◽  
Surgical Excision ◽  
Treatment Protocols ◽  
Post Surgery ◽  
Vincristine Sulphate ◽  
Group A ◽  
Group B ◽  
Canine Transmissible Venereal Tumour ◽  
Transmissible Venereal Tumour

Background: Canine transmissible venereal tumour (CTVT) also known as infectious sarcoma, venereal granuloma, transmissible lymphosarcoma or sticker tumour is usually transmitted through coitus and mainly affects the external genitalia of young sexually matured dogs. Surgery, chemotherapy, radiotherapy and immunotherapy are considered as effective treatment protocols. Therefore, depending upon the availability present study was designed to investigate the efficacy of different surgico-chemotherapeutic protocols for treatment of canine transmissible venereal tumour.Methods: The study was conducted during January 2018 to July 2018 at the Teaching Veterinary Clinical Complex (TVCC) and Department of Veterinary Surgery and Radiology, College of Veterinary Science and A.H., Anjora, Durg (C.G.) on 18 canines of various breed, irrespective of age, sex and divided into three groups consisting 6 animals in each group. Group A was treated with surgical excision of tumour only where as Group B and Group C were treated with surgical excision of tumour followed by administration of Doxorubicin (30mg/m2) BSA and Vincristine sulphate (0.025 mg/kg) intravenously alongwith DNS at 7th and 14th post-operative days respectively. Different physiological and haemato-biochemical parameters (Hb, PCV, TLC, TPC, DLC, serum glucose, TSP, SUN, SC, ALT, AST and ALP) were recorded preoperatively, postoperatively and after chemotherapy at 10th, 30th and 60th days intervals.Result: The present investigation showed transient changes in physiological and haemato-biochemical parameters before, post surgery and post chemotherapeutic management and was within normal range. Histopathological examination revealed confluent sheet of tumour cells arranged in large round oval or polyhedral shaped distributed in tight clusters or cords. Group A showed mild to moderated reoccurrence while Group B showed minimum reoccurrence. Group C showed no reoccurrence. Thus, surgery combined with vincristine therapy is most effective for treating dogs suffering with transmissible venereal tumour.

Comparison of Open and Endoscopic Approaches in the Resection of Esthesioneuroblastoma

2020 ◽  
pp. 000348942093958
Author(s):  
Gregory L. Barinsky ◽  
Monica C. Azmy ◽  
Suat Kilic ◽  
Jordon G. Grube ◽  
Soly Baredes ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endoscopic Surgery ◽  
Olfactory Neuroblastoma ◽  
Endoscopic Approach ◽  
Surgical Approaches ◽  
Open Approach ◽  
Chi Square ◽  
Kaplan Meier ◽  
Open Versus ◽  
Chi Square Analysis

Background: Olfactory neuroblastoma, or esthesioneuroblastoma (ENB), is an uncommon sinonasal malignancy arising from olfactory neuroepithelium that is optimally treated with surgical resection. The objective of this study is to determine preoperative predictors of undergoing open versus endoscopic approach for ENB and to investigate significant postoperative survival outcomes between the two surgical approaches. Methods: The National Cancer Database (NCDB) was queried for cases of ENB histology that were treated surgically from 2010 to 2015. Groups were stratified into open or endoscopic approach cohorts. Patient demographics, tumor characteristics, treatment modality, and 5-year overall survival were compared between the two groups using Chi-Square analysis and Kaplan-Meier survival analysis. Cases were classified as Kadish stage A, B, C, or D based on the “Collaborative Stage-Extension” codes in NCDB. Results: Of 533 patients meeting inclusion criteria, 276 (51.8%) patients underwent open, and 257 (48.2%) patients underwent endoscopic surgical approaches. Patients undergoing endoscopic surgery were more likely to be Kadish stages A and B and less likely to be stages C and D ( P = .020). Those undergoing endoscopic approach overall had a shorter mean hospital stay postoperatively (3.8 vs. 7.0 days, P < .001). Endoscopic cases had a greater 5-year overall survival (81.9% vs. 75.6%, P = .030); after multivariate regression, there was a trend toward survival benefit to endoscopic surgery that did not reach clinical significance (HR 0.644, [0.392-1.058], P = .083). Conclusion: Although not statistically significant, there is a trend toward increased overall survival with an endoscopic approach in patients undergoing surgery for ENB as compared to an open approach, regardless of Kadish stage. An endoscopic approach is an adequate alternative to an open approach for the surgical treatment of ENB.

scholarly journals Juvenile Nasopharyngeal Angiofibroma - Excision Through Lateral Rhinotomy and Sublabial Approach - A Case Report

1970 ◽  
Vol 20 (1) ◽  
pp. 78-81
Author(s):  
NK Sinha ◽  
MH Rashid ◽  
MM Shaheen ◽  
DC Talukder ◽  
MAY Fakir ◽  
...  
Keyword(s):  
Surgical Excision ◽  
Complete Removal ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Complete Excision ◽  
Nasopharyngeal Angiofibroma ◽  
Male Adolescents ◽  
Large Size ◽  
Complete Surgical Excision ◽  
Sublabial Approach

Juvenile angiofibroma is a rare hypervascular, locally aggressive benign tumour which is exclusively found in the nose and paranasal sinuses of male adolescents. The definitive treatment for this tumour is complete surgical excision. Different surgical approaches are used for complete excision. Most recent development is excision of the tumour using endoscopes. But in certain cases with large size and different extensions, open transfacial approaches are the choice for complete removal and for less operative bleeding, which are the main challenges for surgical excision of this tumour. DOI: http://dx.doi.org/10.3329/jdmc.v20i1.8587 J Dhaka Med Coll. 2011; 20(1) :78-81

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