Juvenile nasopharyngeal angiofibroma—20 years of experience in endoscopic treatment

2020 ◽  
Vol 74 (6) ◽  
Author(s):  
Witold Szyfter ◽  
Andrzej Balcerowiak ◽  
Wojciech Gawęcki ◽  
Robert Juszkat ◽  
Małgorzata Wierzbicka
Keyword(s):  
Endoscopic Treatment ◽  
Endoscopic Approach ◽  
Individual Development ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Years Of Experience ◽  
Therapeutic Success ◽  
Nasopharyngeal Angiofibroma ◽  
Imaging Results ◽  
Surgical Methods ◽  
Wide Range

Background: Juvenile nasopharyngeal angiofibroma is a rare, benign tumor; however, it shows local aggression and leads to profuse nosebleeds. The aim of the study is to present 20 years of experience in endoscopic treatment of this tumor. Material and Methods: The material covers 71 patients treated in the years 1985-2019 at the Department of Otolaryngology and Laryngological Oncology in Poznań. In these patients, either the classic external approach, or a double approach—classic with the use of endoscopes—or only the endoscopic approach was used. In the entire population, external surgeries were performed in 30 patients, double access in 8 and endoscopic access in 26 patients. Results: Complete resection of the tumor was achieved in 51 patients (72%). The remaining 20 patients (28%) had a residual or recurrent tumor and all of these patients underwent reoperation. Conclusions: The endoscopic approach with the use of various optics and navigation allows for the removal of not only small tumors but also much more advanced ones. Pre-operative evaluation of imaging results is extremely important to avoid incomplete tumor removal. Individual development of an operating strategy, a wide range of optics and various surgical methods, and especially endoscopic ones, are the guarantee of therapeutic success.

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>

Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma: complications and outcomes

2010 ◽  
Vol 31 (5) ◽  
pp. 343-349 ◽  
Author(s):  
Mojtaba Mohammadi Ardehali ◽  
Seyed-Hadyi Samimi Ardestani ◽  
Nasrin Yazdani ◽  
Hassan Goodarzi ◽  
Shahin Bastaninejad
Keyword(s):  
Endoscopic Approach ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Nasopharyngeal Angiofibroma

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.

scholarly journals Endoscopic Excision of Juvenile Nasopharyngeal Angiofibroma: Case Series of 20 Patients

2020 ◽  
Vol 28 (1) ◽  
pp. 76-79
Author(s):  
Monil Parsana ◽  
Kalpesh Patel ◽  
Abhishek Gugliani
Keyword(s):  
Case Series ◽  
Endoscopic Approach ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Recurrence Rates ◽  
Nasopharyngeal Angiofibroma ◽  
Young Males ◽  
Medical College ◽  
Recurrent Epistaxis ◽  
Life Threatening ◽  
Local Examination

Introduction Juvenile Nasopharyngeal Angiofibroma (JNA) is a highly vascular, benign, locally aggressive tumour of the nasopharynx. Endoscopic approach is the current accepted modality for the excision of Juvenile Nasopharyngeal Angiofibroma. The current study was undertaken to assess the outcome of this procedure at our institute. Materials and Methods A total of 20 patients of JNA at a medical college in Ahmedabad between the period of July 2015 to July 2017 were included. The tumour was staged according to Fisch system and clinical presentation, local examination, nasal endoscopy findings, radiological findings, approach of surgical resection, complications and recurrence were noted. Results  We found that endoscopic approach for the excision of juvenile nasopharyngeal angiofibroma is safe and effective technique associated with reduced post operative morbidity and low recurrence rates.  Conclusions  JNA is a rare but a potentially life-threatening disease. All young males presenting with profuse, spontaneous and recurrent epistaxis should be evaluated for JNA. Endoscopic approaches have become the procedure of choice for resection of these tumours.

Juvenile Nasopharyngeal Angiofibroma

2012 ◽  
Vol 147 (5) ◽  
pp. 958-963 ◽  
Author(s):  
Tam Cloutier ◽  
Yoann Pons ◽  
Jean-Philippe Blancal ◽  
Elisabeth Sauvaget ◽  
Romain Kania ◽  
...  
Keyword(s):  
Residual Disease ◽  
Tertiary Care ◽  
Case Series ◽  
Endoscopic Approach ◽  
University Hospital ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Nasopharyngeal Angiofibroma ◽  
Group 2 ◽  
Group 1

Objective The aim of this study was to review recent management of juvenile nasopharyngeal angiofibroma (JNA) in our institution during the past 10 years and to analyze the shift in surgical paradigm based on the rate of endoscopic approach and Radkowski staging. Study Design Case series with chart review. Setting The study was conducted from April 2000 to August 2010 in a tertiary care university hospital (Lariboisière, Paris, France). Subjects and Methods All patients referred for a JNA were included in the study. Medical files and imaging data were retrospectively analyzed. Surgical management was then evaluated for 2 different periods (group 1, n = 31, consecutive patients operated on from April 2000 to June 2005, and group 2, n = 41, from July 2005 to August 2010). Results Seventy-two patients were operated on, with a mean age of 16.25 years (range, 9-33 years). The rate of the endoscopic approach was significantly higher in group 2 than in group 1 (82.9% vs 45%). Rates of recurrence and complications were similar. Recurrences (ie, residual disease growing and treated by redo) were noted in 6 cases or 8.3% (group 1, n = 3; group 2, n = 3; P > .05). Conclusion Progress in skull base anatomy, instrumentation, cameras, and surgical strategy allows for expansion of the indications for endoscopic removal of JNA. This approach may have a better outcome in terms of blood loss, hospital stay, and local sequelae. Still, an external approach should be considered only for selected cases due to massive intracranial extension or optic nerve or internal carotid artery entrapment by the tumor.

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