Trend analysis in management of juvenile nasopheryngeal angiofibroma: our institutional experience
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20195696Keywords:
Endoscopic method, Juvenile nasopharyngeal angiofibroma, Trend analysisAbstract
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
References
Lund VJ, Stammberger H, Nicolai P, Castelnuovo P, Beal T, Beham A, et al. European rhinologic society advisory board on endoscopic techniques in the management of nose, paranasal sinus and skull base tumours. European Position paper on endoscopic management of the nose, paranasal sinus and skull nase. Rhinol Suppl. 2010;(22):1-143.
Nonogaki S, Campos HG, Butugan O, Soares FA, Mangone FR, Torloni H, et al. Markers of vascular differentiation, proliferation and tissue remodelling in juvenile nasopharyngeal angiofibromas. Exp Ther Med. 2010;1:921-6.
Schick B, Ripple C, Brunner C, Jung V, PLinkert PK, Urbschat S. Numerical sex chromosome aberrations in juvenile angiofibroma: genetic evidence for an androgen dependent tumor? Oncol Rep. 2003;10:1251-5.
Brieger J, Wierzbicka M, Sokolav M, Roth Y, Szyffer W, Mann WJ. Vessel density, proliferation, and immunolocalization of vascular endothelial growth factor in juvenile nasopharyngeal angio-fibromas. Arch Otolaryngol Head Neck Surg. 2004;130(6):727-31.
Marshall AH, Bradley PJ. Management of dilemmas in the treatment and follow up of advanced juvenile nasopharygeal angiofiboma. ORL J Otorhinolaryngol Relat Spec. 2006;68:273-8.
Hackman T, Snyderman CG, Carrau R, Vescan A, Kassam A. Juvenile nasopharyngeal angiofibroma: The expanded endonasal approach. Am J Rhinol Allerg. 2009;23(1):95-9.
Hanna M, Batra PS, Pride GL. Juvenile nasopharyngeal angiofibroma: review of imaging findings and endovascular preoperative embolization strategies. Neurograph. 2014;4:20-32.
Sivanandan E, Willard F. Benign and malignant tumors of the nasopharynx. In: Cummings Otolarynogology: Head and Neck Surgery. Cummings CW, Haughey BH, Thomas JR, Harker LA (Eds.), 4th edtion, Mosby, Philadelphia; 2005:1669-1684.
Andrews JC, Fisch U, Valavanis A, Aeppli U, Makek MS. The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach. Laryngoscope. 1989;99:429-37.
Nicolai P, Castelnuovo P. Benign tumors of sinunasal tract. In: Cummings CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbins KT, et al. (editors). Cummings otolaryngology head and neck surgery. 5th ed. Philadelphia: Mosby Elsevier; 2010:717-727.
Mohammadi Ardehali M, Samimi Ardestani SH, Yazdani N, Goodarzi H, Bastaninejad S. Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma: complications and outcomes. Am J Otolaryngol Head Neck Surg. 2010;31:343-9.
Snyderman CH, Pant H, Carrau RL, Gardner P. A new endoscopic staging system for angiofibromas. Arch Otolaryngol Head Neck Surg. 2010;136(6):588-94.
Mohammadi Ardehali M, Saedi B, Basam A. Effect of embolisation on endoscopic resection of angiofibroma. J Laryngol Otol. 2010;124(6):631-5.
Lloyd G, Howard D, Phelps P. Juvenile angiofibroma: The lessons of 20 years of modern imaging. J Laryngol Otol. 1999;113:127-34.
Hackman T, Snyderman CG, Carrau R, Vescan A, Kassam A. Juvenile nasopharyngeal angiofibroma: The expanded endonasal approach. Am J Rhinol Allerg. 2009;23(1):95-9.
Battaglia P, Turri-Zanoni M, Dallan I. Endoscopic endonasal transpterygoid transmaxillary approach to the infratemporal and upper parapharyngeal tumors. Otolaryngol Head Neck Surg. 2014;150(4):696-702.
Cloutier T, Pons Y, Blancal JP, Sauvaget E, Kania R, Bresson D, et al. Juvenile nasopharyngeal angiofibroma:does the external approach still make sense? Otolaryngol Head Neck Surg. 2012;147(5):958-63.
Khoueir N, Nicolas N, Rohayem Z, Haddad A, Amand WA. Exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma: a systemic review of the literature. Otolarygol Head Neck Surg. 2014;150(3):350-8.
