scholarly journals JUVENILE NASOPHARYNGEALANGIOFIBROMA: OUR EXPERIENCE AND LITERATURE REVIEW

2021 ◽  
Vol 32 (01) ◽  
pp. 03-08
Author(s):  
Adeel Niaz ◽  
Muhammad Iqbal ◽  
Muhammad Ilyas ◽  
Ghulam Dastgir Khan ◽  
Riaz Ahmed Shahid ◽  
...  
Keyword(s):  
Endoscopic Surgery ◽  
Early Stage ◽  
Infratemporal Fossa ◽  
Operating Time ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Nasopharyngeal Angiofibroma ◽  
Sphenopalatine Foramen ◽  
Institutional Review ◽  
Early Tumor ◽  
Hospital Study

ABSTRACT Introduction: Juvenile nasopharyngeal angiofibroma is a benign vasculartumor.It is commonly found in teen age males. Its site of origin is sphenopalatine foramen. Exact pathogenesis of angiofibroma is not known. It has predictable natural history and growth pattern. This tumor most often involves nasopharynx, nasal cavity, paranasal sinuses, pterygopalatine fossa and infratemporal fossa. It can also involve orbit and can spread intracranially. Its very important to diagnose this tumor very early on the basis of clinical examination and imaging. As early tumor confined to nose and sinuses can be removed exclusively with endoscope. It is very helpful to do angiography before surgery to ascertain itsblood supply and then embolization can be done to reduce intraoperative bleeding. Objective: To describe our experience of Juvenile Nasopharyngeal Angiofibroma cases in ENT Unit-I of Lahore General Hospital. Study Design: Descriptive Study with retrospective analysis after approval from Institutional Review Board (IRB) of LGH/PGMI/AMC Lahore. Methods: We studied 20 patients who underwent surgery in our department from October 2019 to October 2020. We analyzed following factors: age, gender, symptoms, staging, mode of surgery and need for intraoperative blood transfusion, hospital stay, complications and recurrences. Results: Range of patient’s age was 12 to 25 years. Eight patients underwent surgery with endoscope. Mean blood loss was about 400 ml and mean operating time was 140 minutes. All the cases were embolized preoperatively. Conclusion: Endoscopic surgery is a safe and effective method in early stage JNA patients. While patients with advance stage tumors should be managed with combined endoscopic and conventional open approaches. KEYWORDS: juvenile nasopharyngeal angiofibroma, JNA, endoscopic surgery  

scholarly journals Juvenile nasopharyngeal angiofibroma – literature review and case series

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.

In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma

2016 ◽  
Vol 130 (5) ◽  
pp. 462-473 ◽  
Author(s):  
A Mishra ◽  
S C Mishra ◽  
V Verma ◽  
H P Singh ◽  
S Kumar ◽  
...  
Keyword(s):  
Residual Disease ◽  
Tumour Size ◽  
Infratemporal Fossa ◽  
Pterygopalatine Fossa ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Atrophic Rhinitis ◽  
Complete Excision ◽  
Nasopharyngeal Angiofibroma ◽  
Transpalatal Approach ◽  
Sublabial Approach

AbstractBackground:Juvenile nasopharyngeal angiofibroma often presents with lateral extensions. In countries with limited resources, selection of a cost-effective and least morbid surgical approach for complete excision is challenging.Methods:Sixty-three patients with juvenile nasopharyngeal angiofibroma, with lateral extensions, underwent transpalatal, transpalatal-circumaxillary (transpterygopalatine) or transpalatal-circumaxillary-sublabial approaches for resection. Clinico-radiological characteristics, tumour volume and intra-operative bleeding were recorded.Results:The transpalatal approach was suitable for extensions involving medial part of pterygopalatine fossa; transpalatal-circumaxillary for extensions involving complete pterygopalatine fossa, with or without partial infratemporal fossa; and transpalatal-circumaxillary-sublabial for extensions involving complete infratemporal fossa, even cheek or temporal fossa up to zygomatic arch. Haemorrhage was greatest with the transpalatal-circumaxillary-sublabial approach, followed by transpalatal approach and transpalatal-circumaxillary approach (1212, 950 and 777 ml respectively). Tumour size (volume) was greatest with the transpalatal-circumaxillary approach, followed by transpalatal-circumaxillary-sublabial approach and transpalatal approach (40, 34 and 29 mm3). There was recurrence in three cases and residual disease in two cases. Long-term morbidity included small palatal perforation (n = 1), trismus (n = 1) and atrophic rhinitis (n = 2).Conclusion:These modified techniques, performed with endoscopic assistance under hypotensive anaesthesia, without embolisation, offer a superior option over other open procedures with regard to morbidity and recurrences.

Juvenile nasopharyngeal angiofibroma with intracranial extension – diagnosis and treatment.

2019 ◽  
Vol 73 (6) ◽  
Author(s):  
Wiesław Gołąbek ◽  
Anna Szymańska ◽  
Marcin Szymański ◽  
Elżbieta Czekajska-Chehab ◽  
Tomasz Jargiełło
Keyword(s):  
Infratemporal Fossa ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Radiological Findings ◽  
Superior Orbital Fissure ◽  
Nasopharyngeal Angiofibroma ◽  
Therapeutic Modalities ◽  
Stage Ivb ◽  
Extensive Involvement

Introduction This retrospective study analyzes radiological findings, therapeutic management and outcomes of patients with intracranial extension of juvenile nasopharyngeal angiofibroma (JNA). The routes of intracranial spread, incidence of intracranial disease and influence on therapeutic approach are discussed. Material and methods An evaluation on the records of 62 patients with JNA was performed and 10 patients with intracranial tumors were included in the study. All patients were males aged 10 to 19 years. Results According to Andrews' classification 8 patients presented with stage IIIb, 1 patient stage IVa and another patient stage IVb tumor. Intracranial invasion was extradural in 8 cases and intradural in 2 patient. Surgery was performed in 9 cases and the most common was combined approach: infratemporal fossa and sublabial transantral. One patient was referred for radiotherapy. Follow-up ranged from 8 to 26 years. There was extracranial recurrence in 2 (22%) of 9 operated patients. Conclusions The superior orbital fissure is the most frequent route of intracranial spread in patients with extensive involvement of the infratemporal fossa. Due to high risk of recurrence and potential serious complications advanced cases of JNA should be managed by experienced multidisciplinary team, preferably in tertiary referral centers, with an access to modern diagnostic and therapeutic modalities.

scholarly journals Surgical management of juvenile nasopharyngeal angiofibroma using lateral rhinotomy: study of 80 cases

2011 ◽  
Vol 1 (2) ◽  
pp. 34
Author(s):  
Ninad Gaikwad ◽  
Nilam Sathe ◽  
Abhijeet Bhatia ◽  
Dhanashree Chiplunkar ◽  
Manoj Patil
Keyword(s):  
Infratemporal Fossa ◽  
The Body ◽  
The Other ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Lateral Rhinotomy ◽  
Temporal Fossa ◽  
Nasopharyngeal Angiofibroma ◽  
Lateral Skull Base ◽  
Operative Complications

A series of 80 patients with histopathologically confirmed juvenile nasopharyngeal angiofibroma were treated surgically over a period of ten years (1995-2004). The lateral rhinotomy approach was used to expose the tumor and its extensions. Lateral rhinotomy with its extensions provides wide exposure of and access to the nose, nasopharynx, paranasal sinuses, pterygopalatine fossa, infratemporal fossa and temporal fossa. Most intracranial, extradural extensions can also be approached. There were no major operative or post-operative complications. Longterm follow up from one to ten years showed only 8 recurrences. The added advantage of this approach is that it can be combined with all the other anterior and lateral skull base approaches. The cosmetic outcome is satisfactory if nasal aesthetic subunits are taken into considerations while making the incision. The lateral rhinotomy approach is the most direct route to the body of the tumor and can be used to approach all the possible extensions of the tumor.

scholarly journals Nasomaxillary Swing - A Novel Approach for Bilateral Angiofibroma

2009 ◽  
Vol 2 (3) ◽  
pp. 33-36 ◽  
Author(s):  
Alok Thakar ◽  
Gaurav Gupta ◽  
Mohnish Grover
Keyword(s):  
High Risk ◽  
Infratemporal Fossa ◽  
Complete Removal ◽  
Adolescent Males ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Nasopharyngeal Angiofibroma ◽  
Surgical Exposure ◽  
Novel Approach ◽  
High Risk Tumor

Abstract Juvenile nasopharyngeal angiofibroma (JNA) is a high-risk tumor of adolescent males. Choice of the approach should be based on the stage and site of the lesion. For complete removal of tumor, surgical exposure must be adequate. We here present a case of nasopharyngeal angiofibroma with intracranial and bilateral infratemporal fossa extension in which tumor was completely excised by nasomaxillary swing approach.

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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