Juvenile nasopharyngeal angiofibroma: A single institution study (original) (raw)
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A seven-year experience with patients with juvenile nasopharyngeal angiofibroma
Juveni le nasopharyngeal angiofibroma (JNA) is a rare tumor in adolescent males. It originates in the nasopharynx. Aim: to present the experience of JNA management at an Otorhinolaryngology Service between 2001 and 2008. Materials and Methods: Demographical data, clinical presentation, investigations as well as the treatment of sixteen JNA patients were reviewed and collected from medical records from the ORL Service. Design: Cross-sectional, retrospective and descriptive study. Results: All JNA patients were male. The average age at diagnosis was 16.8 years (range 9-23 years). More than 56% of the patients were classified as Fisch II. Preoperative embolization was carried out in ten (62.5%) patients. All 16 patients were submitted to primary surgical resection. Two patients (66.7%) who didn't receive preoperative embolization required intraoperative blood transfusion. The overall recurrence rate was 43.75% and the cure rate was 93.75%. Conclusion: Preoperative embolization minimizes intraoperative blood loss. The recurrence rate was related to advanced tumoral stage at diagnostic and the lack of preoperative embolization. Surgery combined with preoperative embolization is the major treatment for JNA. All the patients should undergo preoperative imaging studies, especially CT, to assist in surgical planning and follow-up.
Juvenile Nasopharyngeal Angiofibroma: Changing Paradigms in Management
Bengal Journal of Otolaryngology and Head Neck Surgery, 2018
Introduction Juvenile Nasopharyngeal Angiofibroma (JNA) is a tumor of young and adolescent males. It is a benign vascular tumor arising from the spheno-palatine foramen. It is best managed surgically at present by endoscopic methods with or without pre-operative embolization. Tumor attributes like intracranial extent and residual vascularity after embolization need to be assessed pre-operatively before undertaking endoscopic surgery, in order to reduce surgical blood loss and morbidity. Materials and Methods Twenty-three cases of JNA (n=23) were operated endoscopically at a tertiary level military hospital. They were staged with the Snyderman staging system. Demographic variables including stage wise management were brought out with intraoperative time and blood loss recorded for different stages. Results The intraoperative surgical time, intra-operative blood loss and recurrence/residual rates were compared with similar studies in exis...
The changing surgical management of juvenile nasopharyngeal angiofibroma
European Archives of Oto-Rhino-Laryngology, 2011
The management of juvenile nasopharyngeal angioWbroma (JNA) has changed during the last decades but it still continues to be a challenge for the multidisciplinary head and neck surgical team. The aim of this study was to review the used treatment approach and outcome of JNA in a single institution series of 27 patients diagnosed and treated during the years 1970-2009. All patients were male, with the median age of 17 years (range 11-33 years). Surgery was used as the primary treatment in every case. Surgical approaches varied, transpalatal approach (N = 14) being the most common approach used in this series. During the last decade various other techniques were applied, including endoscopic (N = 3) resection. Two patients were additionally treated with antiangiogenic agents and one patient with stereotactic radiotherapy. The primary recurrence rate was 37% and it seemed to correlate with vascular density of tumour and the surgical approach used. We suggest that the management of JNA should be planned by an experienced head and neck surgeon, as part of a multidisciplinary team, preferably in a tertiary referral setting, and the recent development of the available therapies should be taken into account to minimise the risk of recurrence.
Lefort 1 Access for Juvenile Nasopharyngeal Angiofibroma Treated Without Angiographic Embolization
Pakistan Journal of Neurological Sciences, 2017
BACKGROUND To assess and analyze the clinical presentation of Juvenile nasopharyngeal angiofibroma and analyze the complications associated with JNA resection without pre surgical embolization using LeFort 1. METHOD This retrospective study conducted at the Department of Neurosurgery,CHK(Civil Hospital Karachi, DUHS(Dow University of Health Sciences), Karachi, Pakistan involves the review of medical records of patients with histologically confirmed Juvenile nasopharyngeal angiofibroma who were treated in between 2014-2016 RESULTS 25 patients were identified, with an average age of 14.5 years (9-20years). Majority of the patients presented with epistaxis. CT scan was the most commonly used radiological investigation for staging. According to RADKOWSKI staging 16 patients (64%) presented with stage IIIb. 6 patient (24%) presented with stage IIIa and 3 patients (12%) presented with stage IIc. Tumor recurrence was seen in 2 patients (8%) while malocclusion was seen in 1 patient (4%). CO...
Appraisal of clinical profile and management of juvenile nasopharyngeal angiofibroma in malaysia
The Malaysian journal of medical sciences : MJMS, 2007
Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally invasive tumour. Patients are usually in their adolescent age and present with epistaxis and nasal blockage. Diagnosis is based on clinical evaluation and the C.T. scan findings. Pre-operative superselective embolisation (SSE) and surgical excision is the treatment of choice. The out patient clinic of ORL-HNS hospital of University Science Malaysia received 25 referrals, all male, majority between 9-13 years of age and few adolescents. Clinically the patients were consistent with symptoms of recurrent epistaxis and nasal blockage. They reported from October 1998 to October 2001 from with in the state of Kelantan and the nearby states of Pahang, Kedah and Terenganu. Diagnosis was mostly made on typical radiological findings and the tumours were classified accordingly into four stages. SSE and surgical excision was carried out in all cases. Regular follow-up helped us to identify early recurrences which were treated wi...
Clinico-Pathological Study of Juvenile Nasopharyngeal Angiofibroma
American Journal of Biomedical and Life Sciences
Introduction: Anigo-fibroma is vascular swelling arising in the nasopharynx of prepubertal and adolescent males and exhibiting strong tendency to bleed, also termed as nasopharyngeal fibroma or a nasopharyngeal angiofibroma. It accounts for less than 0.5% of all head & neck tumour. It occurs almost exclusively in adolescent male, though rarely found in children and elderly young. It is a rare <1% of head and neck tumors benign mesenchymal neoplasm composed of a vascular proliferation within a cellular, densely collagenizedstroma, typically originating in the nasopharynx, affecting adolescent males. It occurs most often in male adolescents with an average age at diagnosis of 14-16 years. Anyway, there are very few studies, regarding Juvenile Nasopharyngeal Angiofibroma in Bangladrsh and there is not much national data about this issue. Hence, the researcher purposively a total of 30 patients of juvenile nasophryngeal angiofibroma (JNA) included in this study from ENT department of Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh. The aim of this study was to find out the common mode of clinical presentation with their site of extension and different surgical approaches adopted for them. Methods& Materials: This prospective observational study was conducted in the Department of otolaryngology and head, neck surgery of Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh, which is the 2 nd generation tertiary level medical service institution during the period from Jan 2017 to Dec 2019. All data were analyzed by using simple statistical data analyzed tools. Result: Almost all the present with recurrent epistaxis 28 (93.33%), following by nasal obstruction 26 (86.66%), nasal discharge 25 (83.33%), facial swelling 10 (33.33%), protrusion of the eyeball 4 (13.33%), aural symptoms 3 (10%) and headache 2 (6.66%). Majority of our patient presented with multiple symptoms. Analysis of the finding showed that 100% had nasopharyngeal mass, nasal mass 86.66% palatal bulging 66.66%, swelling of the cheek 33.33%, proptosis 13.33% and headache with blurring of vision 6.66%, these are obtained after thorough clinical examination both local and general. Extension of the tumour assessed on the basis C scan, MRI, as well as observation on the operation showed, nasal cavity 100% and into the pterygopalantine fossa 40%, infratemporal fossa 33.33%, orbit 13.33%, oropharynx 10% maxillary antrum 6.66%, sphenoid sinus 3.33%, ethmoidal sinus 3.33% and 6.66% infra oranial extension. Regarding treatment surgical resection was the most common principal mode of treatment offered to the 93.33% patient but radiotherapy given in 6.66% patient. Conclusion: All young males of this study with nasal obstruction or nose bleed (or both) should be suspected of having juvenile angiofibroma. Angiography to find out feeding vessel to do pre-operative embolization is helpful for surgery. This together with hypotensive anaesthesia and operated by a skilled surgeon having sound knowledge about nasopharynx can lessen the haemorrhage, thereby reduce the mortality and morbidity.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2002
This study is a retrospective analysis of 30 consecutive cases of Juvenile Nasopharyngeal Angiofibroma (JXA) operated at. Department of Head and Neck Surgery, Kidwai Memorial Institute of Oncology Bangalore, India: la tertiary referral centre) after prior emohilization by an interventional neuro-radiologisl (1996-2002). This study discusses critically the planning of surgical approach, based on anatomico-radiological factors and highlights the efficacy of preoperalive embolization in expediting total re moral of the tumor in 25 out of JO cases with advanced stage JNA. To analyze the utility of pre-operatire embolisation in surgical extirpation of large JNAs; planning of the surgical approaches based on CT topography of the tumor; to study the various complications of embolisation and surgery associated with JXA & lastly to evaluate the puttern and location of recurrent tumor thus correlating with the original topography. Tertiary care cancer referral centre. PATIENTS ranged in age f...
Acta Neurochirurgica, 2011
Background Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor occurring almost exclusively in adolescent and young adult males. The tumor is characterized by slow progression, aggressive growth, high vascularization, and increased rate of persistence and recurrence. The aim of this study was to describe a case of giant JNA from our practice and discuss the controversies of surgical treatment of advanced JNA. Material and methods A series of 29 consecutive male patients with JNA Fisch grade III and IV was surgically treated in Burdenko Neurosurgical Institute from 2000 until 2008. In the vast majority of cases, endovascular embolization and surgical removal via orbitozygomatic approach were applied. Results Gross total resection was achieved in 24 cases (83%). Complications were encountered in eight cases. No mortality was observed. In three patients, the diseases recurred. An illustrative case is described. Conclusion Surgical treatment is the basic tactics in management of extensive JNA including endovascular embolization and resection of the tumor. We recommend using orbitozygomatic approach or its modifications in JNA. Radiation therapy may be recommended for patients with small residual tumor.
Management of Juvenile Nasopharyngeal Angiofibroma: A
2010
Juvenile nasopharyngeal angiofibroma is a pathologically benign yet locally aggressive and destructive vascular lesion of head and neck region typically affecting adolescent boys. The present article is a retrospective study of surgically treated patients of juvenile nasopharyngeal angiofibroma over a period of 5 years. The study discusses about most common presenting complaints, correlation of preoperative radiological and intraoperative staging and factors affecting recurrence of juvenile nasopharyngeal angiofibroma.
Juvenile Nasopharyngeal Angiofibroma
Archives of Pediatrics & Adolescent Medicine, 1981
Review of the literature was performed to define the optimal treatment of patients with juvenile nasopharyngeal angiofibroma (JNA). The prognosis for this disease is extremely good if diagnosed well in time and if the tumor has not extended intracranially. Preoperative selective arterial embolization has decreased intraoperative blood loss and facilitated resection of larger tumors. Transnasal endoscopic resection preserves both the anatomy and physiology of the nose, requires less rehabilitation days after surgery, and is highly successful for selected patients. Radiation therapy is generally reserved for larger and/or unressectable tumors but has severe complications. Radiosurgery has several advantages over surgery or classic radiation therapy. However, further experiences and studies are required to confirm the usefulness of radiosurgery on JNA.