Nasopharyngeal Fibroma

Abstract

W. McC., age 17 years. This patient attended E.N.T. Extern and was admitted to the Royal Victoria Hospital on the 16th September, 1949. He complained of nasal obstruction for one year which was noticed first on the right side and later on the left. Four months before admission he had a severe epistaxis, during which he lost a considerable amount of blood. He was treated six months previously for meningitis andl was in Purdysburn Fever Hospital for three weeks. He also complained of a certain degree of deafness.On examination, he was a healthy looking male subject. Throat.-Tonsils were large, no infection. Pharynx.-There were several large veins visible on the posterior pharyngeal wall going up into the naso-pharynx.Nose.-The septum was deviated to the right. 'lhere was hypertrophic rhinitis and muco-pus present in both nostrils.POSTERIOR RHINOSCOPY. The naso-pharynx was filled by a large tumour which was blocking both choanae and on palpation bled profusely.X-ray.-There was a soft tissue mass approximately 2 cms. in diameter projecting forwards and filling up the naso-pharynx. There was considerable erosion of the roof of the naso-pharynx with extension of the soft tissue into the sphenoidal air sinus. The right frontal sinus showed loss of translucency, and mucosal thickening was present in both antra.A biopsy of the tumour was carried out and this was attended by very severe hoemorrhage, which required almost an hour to stem.In view of the difficulties of surgery in this case a course of deep X-ray therapy was given, but no change in the size of the tumour or the patient's symptoms was noted. It was finally decided that surgical removal should be attempted. Preoperatively the patient was blood grouped and a transfusion started on the table. OPERATION.The uvula and soft palate were split in the midline and retraction carried out.This gave a moderate exposure of the tumour. The tumour was incised with a cutting diathermy current and bleeding became extremely severe. It was removed by blunt dissection. The tumour was very adherent to the surrounding walls.It was found to have eroded the floor of the sphenoidal sinus and exposed the basi-occiput. It extended into the nose and invaded the free edge of the hard palate.

Multiple extra-nasopharyngeal extensions of juvenile nasopharyngeal angiofibroma

“…ii) Directly forwards, into the maxillary antrum, iii) Through the pterygomaxillary fissure, to the cheek and temporal regions. The various cases reported in literature have presented mainly with cheek extensions (Bhatia et al, 1967;Gupta and Gupta, 1971;Patil etal., 1982) a few with extensions into the cranial cavity (Hunter et al, 1963) and into the nasal cavity and nostril (De, 1977).…”