Endoscopic Approach to Fisch Stage II to III-b Juvenile Nasopharyngeal Angiofibroma

Baser, Brajendra; Kothari, Shenal; Kinger, Arvind

doi:10.1007/s12070-010-0061-1

Cited by 6 publications

(7 citation statements)

References 8 publications

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“…4,5 With the evolution of endoscopic techniques, it has now become possible to successfully resect also class III tumors less invasively. 6 Various studies recently showed that the endoscopic technique seems to be superior not only regarding morbidity but also in visualization of persisting tumor tissue, blood loss, time spent in the hospital, and recurrences. 7,8 Although surgical techniques are evolved, the resection of JNA remains a demanding task that requires surgical expertise.…”

Section: Introductionmentioning

confidence: 99%

Morbidity and Volumetric Progression in Juvenile Nasopharyngeal Angiofibroma in a Long-Term Follow-Up

et al. 2018

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Objective We compare the open and transnasal approaches for the excision of juvenile nasopharyngeal angiofibromas regarding the rate of morbidity, and residual tumor and its symptomatic recurrence over time. In addition, we present volumetric measurements of juvenile nasopharyngeal angiofibromas over time. Methods All surgically treated patients of our institution were reviewed back to 1969 for type of surgery, residual tumor by magnetic resonance imaging (MRI)-based volumetry, recurrence, and morbidity. We performed a prospective clinical and radiological follow-up on reachable patients. Results In total, 40 patients were retrievable from our records. We were able to follow up on 13 patients after a mean of 15.7 years since surgery (range: 1–47 years). Patients operated by the open approach had a higher rate of postoperative complications and thus a higher morbidity than endoscopic patients (4/4 vs 3/9; p = 0.007), although tumor sizes were equal among groups (p = 0.12). Persisting tumor was noted in 3/4 and 4/9 (p = 0.56) patients, respectively. The corresponding mean volumes of residual tumors were 16.2 ± 14.4 cm3 and 10.8 ± 6.6 cm3 (p = 0.27). No progression could be noted in endoscopically treated patients (p = 0.24, mean time between scans 2 years). Conclusions Our analysis shows that the endoscopic approach results in less morbidity. The open approach does not guarantee freedom from persisting tumor tissue. Age seems to be a most important risk factor for the conversion of an asymptomatic persistence into a symptomatic recurrence.

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Section: Introductionmentioning

confidence: 99%

Morbidity and Volumetric Progression in Juvenile Nasopharyngeal Angiofibroma in a Long-Term Follow-Up

et al. 2018

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“…The patient presents with recurrent epistaxis and nasal blockage with intranasal mass, cheek swelling, visual changes, hearing impairment and neurological deficits may be present sometimes [4].…”

Section: Introductionmentioning

confidence: 99%

“…Various management options for control of JNA, include surgery, radiotherapy, chemotherapy, hormonal therapy and electrocoagulation. Surgery remains the mainstay of treatment [4]. Surgical approaches range from extensive mid facial degloving to minimally invasive transnasal endoscopic excision.…”

Section: Introductionmentioning

confidence: 99%

“…Open approaches give the benefit of wider exposure but with high morbidity, more hospitalisation, more bleeding, facial disfigurement, sometimes delayed bone growth in children [4] With the evolution of endoscopic surgery, better instrumentation and greater experience in the field, it is now imperative to aid conventional surgical techniques with the telescopes. Here we describe combined approach of transpalatal and endoscopic for its removal.…”

Section: Introductionmentioning

confidence: 99%

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Juvenile Nasopharyngeal Angiofibroma: Combined Approach for Excision, Transpalatal and Endoscopic; A New Perspective

Gupta

Agarwal

2016

Indian J Otolaryngol Head Neck Surg

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Juvenile angiofibroma is a rare, highly vascular, histologically benign but locally invasive tumour, affecting predominantly male adolescents. To describe our experience in diagnosis of angiofibroma and treatment by combined endoscopic and transpalatal route. We analysed a case series of 50 patients of nasopharyngeal angiofibroma in Fisch stages I and II who presented at our institute during a period of four years 2011-2014, their clinical presentation, their treatment by combined transpalatal and endoscopic approach, intraoperative and post operative course, complications and tumour recurrence. Patients were aged 8-26 years. All patients were treated surgically by combined approach endoscopic and transpalatal. The mean operation time was 90 min, and the mean bleeding volume was 300 ml. Only 8 % patients came with recurrence and only 10 % came with palatal perforation (fistula formation). With gratifying results we advocate this novel technique for the treatment of early to intermediate JNA.

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“…It occurs almost exclusively in adolescent males and forms 0.05% of all head and neck neoplasms [1,2]. This decade has witnessed a new armamentarium of diagnostic techniques that have revolutionized the management of JNA.…”

Section: Introductionmentioning

confidence: 99%

Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign

Janakiram¹,

Sharma²,

Samavedam³

et al. 2016

Indian J Otolaryngol Head Neck Surg

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Imaging plays an important role in the diagnosis, staging and prognosis of JNA. Certain radiological changes as seen on CECT were observed to be consistent in our case series. This study analysed preoperative and postoperative CECT of large series of JNA patients to evaluate the sites and pattern of spread of tumor. We evaluated the clinical significance of pterygoid wedge in preoperative and postoperative imaging and thus elucidating two new radiological signs. Retrospective analysis of the pre operative and post operative imaging data of 242 patients with JNA. The findings in the scan were clinically correlated with the endoscopic intraoperative findings. Preoperative evaluation of the pterygoid wedge revealed widening on the involved side in 99.1% of our cases which is 1.8 times greater compared to the uninvolved side. The possibility of residual/recurrent tumor was found to be significantly higher in those where the pterygoid wedge was not removed by drilling (p \ 0.001) Drilling of the pterygoid wedge intra operatively, reduced the rate of residual/recurrence from 31.9 to 3.07%. Widening of the pterygoid wedge seen in the preoperative CECT, referred as RAM HARAN sign occurs in JNA. It has a significant diagnostic value as a radiological sign in JNA. Drilling of the pterygoid wedge intraoperatively reduces the rate of recurrence of JNA. Appearance of the two pterygoid plates on postoperative CECT, as two parallel lines, referred as Chopstick sign, has a remarkable prognostic value as a radiological sign in JNA.

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Endoscopic Approach to Fisch Stage II to III-b Juvenile Nasopharyngeal Angiofibroma

Cited by 6 publications

References 8 publications

Morbidity and Volumetric Progression in Juvenile Nasopharyngeal Angiofibroma in a Long-Term Follow-Up

Morbidity and Volumetric Progression in Juvenile Nasopharyngeal Angiofibroma in a Long-Term Follow-Up

Juvenile Nasopharyngeal Angiofibroma: Combined Approach for Excision, Transpalatal and Endoscopic; A New Perspective

Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign

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