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 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.

Nasopharyngeal angiofibroma: (A nine-year experience)

1988 ◽  
Vol 102 (9) ◽  
pp. 805-809 ◽  
Author(s):  
D. A. Tandon ◽  
S. Bahadur ◽  
S. K. Kacker ◽  
R. K. Goulatia
Keyword(s):  
Blood Loss ◽  
Stage Iv ◽  
Staging System ◽  
Lateral Spread ◽  
Intracranial Extension ◽  
New Delhi ◽  
Medical Sciences ◽  
Nasopharyngeal Angiofibroma ◽  
Recurrent Tumour ◽  
Sphenoid Sinuses

AbstractIn a nine-year period 50 nasopharyngeal angiofibromas, of whom 13 had recurrent tumour, were treated surgically at the All India Institute of Medical Sciences, New Delhi. A new staging system according to the regions involved was used; 31 patients in whom the tumour was limited to the nasopharynx (Stage I) and those with superior spread into the ethmoid or sphenoid sinuses (Stage IIA) had their tumours removed by a transpalatal route, alone or in combination with other approaches. Tumours with lateral extensions into the pterygopalatine or infratemporal fossae or the cheek (Stage IIB), and those with simultaneous superior and lateral spread (Stage HI) underwent a transmaxillary excision (19 cases). In two of the three cases with intracranial extension (Stage IV), the tumour was removed successfully from below. There was no mortality. The usefulness of the transmaxillary approach, especially in recurrent cases, is emphasized. No adjuvant modalities were employed in this series and blood loss was acceptable.

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 Removal of Angiofibroma with Maxillary and Mandibular Swing: A Clinical Report

2012 ◽  
Vol 4 (3) ◽  
pp. 151-155
Author(s):  
Chetan V Ghorpade ◽  
Ravi P Deo ◽  
Raghuji D Thorat ◽  
Snigdha D Devane
Keyword(s):  
Good Control ◽  
Vascular Tumor ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Clinical Report ◽  
Nasopharyngeal Angiofibroma ◽  
Local Infiltration ◽  
Visible Scar ◽  
Mandibular Swing ◽  
Maximum Exposure

ABSTRACT Juvenile nasopharyngeal angiofibroma is vascular tumor found in adolescent males. With development of endoscopic fraternity, tumor can be addressed successfully with endoscopic approach; but one needs maximum exposure for large angiofibroma with local infiltration around. Maxillary and mandibular swing technique for removal of the tumor gives excellent exposure and good control on vascularity of the tumor. Postoperative follow-up for 1 year has shown minimal visible scar, cosmetic deformity in the patient. How to cite this article Ghorpade CV, Deo RP, Thorat RD, Devane SD. Removal of Angiofibroma with Maxillary and Mandibular Swing: A Clinical Report. Int J Otorhinolaryngol Clin 2012;4(3):151-155.

scholarly journals Nasal Septal Angiofibroma

2021 ◽  
pp. 014556132110265
Author(s):  
Oratile Thobejane ◽  
Shivesh Maharaj
Keyword(s):  
Computed Tomography ◽  
Clinical Presentation ◽  
Vascular Tumor ◽  
Adolescent Males ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Computed Tomography Scan ◽  
Excessive Bleeding ◽  
Nasopharyngeal Angiofibroma ◽  
Extranasopharyngeal Angiofibroma ◽  
Tomography Scan

Juvenile nasopharyngeal angiofibroma is a benign vascular tumor seen predominantly in adolescent males in the second decade of life. Extranasopharyngeal angiofibroma includes vascular fibrous masses that occur outside the nasopharynx. The diagnosis of an angiofibroma is based on the clinical presentation and imaging, with biopsies being avoided to avoid excessive bleeding. Computed tomography scan is considered sufficient for the diagnosis of extranasopharyngeal angiofibroma as it clearly delineates and identifies the tumor.

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

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