Juvenile Nasopharyngeal Angiofibroma: A Rise in Incidence

Abstract

Juvenile nasopharyngeal angiofibroma is a very rare, highly vascular, uncapsulated and locally invasive tumor. Recently a changing trend has been seen in its epidemiology, pathogenesis, diagnosis, medical management, pre-operative care, surgical management and postoperative care including radiotherapy. Study the changing trend basically in the north-eastern region of south-east Asia and its prospects. Retrospective study of patients presenting with JNA between the study period of 6 months (October 2014-March 2015 in the, Department of Otolaryngology and Head and Neck Surgery, Assam Medical College, Dibrugarh, Assam, India. Incidence in comparison to previous studies has increased. Eight patients were treated in the study period. Different approaches were used. Mean age of presentation was 18 years and more than 75 % of them were either Stage III or Stage IV. Different approaches like transpalatine, transpalatine along with transnasal, lateral rhinotomy and endoscopic surgery were used. The recurrence rate was 12.5 %. Surgery by transpalatine approach should be the choice of treatment. Endoscopic resection should be only used for Stage I or Stage II disease.

Clinicopathological Study of Juvenile Nasopharyngeal Angiofibroma; a Single Institution Study in a Tertiary Care Hospital In Odisha

“…In our study majority(70%) of patients present with both epistaxis & nasal obstruction along with other symptoms corroborative to study of dr RK pandey et all & A Eterzian; [14,18] contrast to study byPrusty NM et al & Paris J et al, [1517] where nasal obstruction is the most common presentation.20% of our case present with epistaxis without nasal obstruction, which is due to initial stage of disease, mass not occluding choana or nasal cavity & more vascular component of tumor.10% cases present with nasal obstruction without epistaxis which may be due to more fibrous component of the tumor, like study of A E. TERZIAN, [14] where nasal obstruction is common symptom. In our study Recurrent epistaxis & Nasal obstruction is the most common presentation similar to study of Gaillard A L et al, [15] Tang IP et al, [22] prusty NM et al & Tiwari P K et al [15,20] Epistaxis was the most distressing symptom of all which made the patients to seek medical advice early. 12 patients came for ENT consultation on first episode of epistaxis though other symptoms were already present for a long duration.…”

A Comprehensive Review of Pediatric Tumors and Associated Cancer Predisposition Syndromes

“…JNA is a rare tumor of the nasopharynx that is highly vascular and locally invasive and accounts for far less than 1% of all head and neck cancers. The tumor typically affects young males between the ages of 14-25 years (Coutinho-Camillo et al 2008;Tiwari et al 2016). JNA's are diagnosed 25 times more frequently in patients with FAP than in the general population (Abraham et al 2001;Ferouz et al 1995).…”

Coblation Assisted Endoscopic Excision of Juvenile Nasopharyngeal Angiofibroma- An Institutional Observational Study

“…Surgery is considered as the mainstay in the management of JNA. Various open surgical approaches have been employed traditionally for the resection of JNA like Transpalatine approach, Sardana's approach, Lateral rhinotomy, Midfacial degloving, and Neurosurgical approaches [1,2,3,8]. Now different endoscopic approaches like Modified Denkers, Medial maxillectomy, Transpterigoid are currently used for JNA removal.…”

“…Use of coblation in endoscopic nasal surgery has significantly improved and simplified the management of JNA. Coblation in JNA decreases chance of intraoperative bleeding, causes controlled debulking of the tumors, decreases requirements for multiple instrumentation, and improves visualization of surgical field as it has inbuilt suction apparatus [8,10]. Coblation is the plasma technology which creates relatively low temperature (60-70℃) in surgical field which can coagulate and ablate the lesion simultaneously [10].…”