ROLE OF SURGICAL APPROACHES: INFLUENCING TUMOUR RECURRENCE IN NASOPHARYNGEAL ANGIOFIBROMA

Authors

  • Raza Muhammad Department of ENT, Ayub Teaching Hospital Abbottabad
  • Altaf Hussain Pakistan Institute of Medical Sciences, Islamabad
  • Fazal Rehman Hayatabad Medical Complex, Peshawar
  • Johar Iqbal Hayatabad Medical Complex, Peshawar
  • Munib Khan Hayatabad Medical Complex, Peshawar
  • Gohar Ullah Hayatabad Medical Complex, Peshawar
  • Zakir Khan Department of ENT, Ayub Teaching Hospital Abbottabad

Abstract

Background:  Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon tumour constituting less than 1% of all head & neck tumours. This tumour has an aggressive local behaviour if left untreated. Surgery is the mainstay of treatmentwith no common consensus on a single approach. Tumour stage and surgical approaches are the major determinants of outcome. The objective of this study was to evaluate the influence of surgical approaches on tumour recurrence in patients with nasopharyngeal angiofibroma. Methods: This descriptive study was conducted in the Department of ENT and Head and Neck Surgery, PIMS, Islamabad and Ayub Medical Institution, Abbottabad from Jan 2010 to Jan 2014 consisting of 34 diagnosed cases of nasopharyngeal angiofibroma. All patients were treated surgically while radiotherapy was given in a few. All patients were followed up for one year. Results: Among 34 patients, 25 were treated by lateral rhinotomy approach with medial maxillectomy, 5 by mid-facial degloving approach and 3 by transpalatine approach. One patient with cavernous sinus involvement was treated by radiotherapy. Patients were followed up for one year both by clinical examination and imaging if needed. Recurrence was found in 15% (5/33) patients and postop radiotherapy was given to them. Conclusion: Lateral rhinotomy approach with medial maxillectomy is highly effective even in advanced stage JNA for complete removal of the disease. Postoperative radiotherapy is an effective adjuvant.Keywords: Juvenile nasopharyngeal angiofibroma, Lateral rhinotomy, recurrence

References

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.

Patrocinio JA, Patrocinio LG, Borba BH, Bonatti Bde S, Guimaraes AH. Nasopharyngeal angiofibroma in an elderly woman: Am J Otolaryngol 2005;26:198–200.

Paris J, Guelfucci B, Moulin G, Zanaret M, Triglia JM. Diagnosis and treatment of juvenile nasopharyngeal angiofibroma. Eur Arch Otorhinolaryngol 2001;258:120–4.

Dubey SP, Molumi CP. Critical look at the surgical approaches of nasopharyngeal angiofibroma excision and "total maxillary swing" as a possible alternative. Ann Otol Rhinol Laryngol 2007;116:723–30.

Nong D, Tang A, Xu Z,Nong H, Liang Y, Wang D, et al. Clinical study of juvenile nasopharyngeal angiofibroma: Lin Chuang Er Bi Yan Hou Ke Za Zhi 2006;20:70–2.

Tyagi I, Syal R, Goyal A. Staging and surgical approaches in large juvenile angiofibroma--study of 95 cases. Int J Pediatr Otorhinolaryngol 2006 ;70:1619–27.

Hanamure Y, Tanaka N, Kawabata T, Kasano F, Kashima N. Juvenile nasopharyngeal angiofibroma: stage and surgical approach. Nippon Jibiinkoka Gakkai Kaiho 2005;108:513–21.

Tosun F, Ozer C, Gerek M, Yetiser S. Surgical approaches for nasopharyngeal angiofibroma: comparative analysis and current trends. J Craniofac Surg 2006;17:15–20.

Browne JD, Jacob SL. Temporal approach for resection of juvenile nasopharyngeal angiofibromas. Laryngoscope 2000;110:1287–93.

Ziadi SH, Jafery IH. Juvenile Nasopharyngeal angiofibroma. Pak J Otolaryngol 1988;4:77–84.

Iqbal SM, Hussain SI. Surgical management of Juvenile nasopharyngeal angiofibroma with and without preoperative embolization. A comparative analysis. Med Channel 2006;12(1):68–70.

Cheema KM, Hameed A. Juvenile angiofibroma: Diagnostic workup and review of literature. Ann King Edward Med Uni 1999;5(3,4):222-4.

Shahabi I, Javaid M, Khan IA, Zada B. Angiofibroma-A Surgical challenge- an experience with twenty cases. J Med Sci 2005;13(2):122–7.

Gohar MS, Rashid D, Ahmed B. Common presenting symptoms, diagnosis and management of angiofibroma. Pak J Med Sci 2004;20(4)377–80.

Shahabi I, Jan A, Ahmad I, Khan A. Surgical approaches used for the excision of angiofibroma. J Postgrad Med Institute 2006:15;46–50.

Beham A, Fletcher CD, Kains J, Schmid C, Humer U. Nasopharyngeal angiofibroma; an immunohistochemical study of 32 cases. Virchows Arch A Pathol Anat Histopthol 1993;423(4):281–5.

Steinberg SS. Pathology of juvenile nasopharyngeal angiofibroma. A lesion of adolescent males. Cancer 1954;7:15–28.

Jacobsson M, Petruson B, Ruth M, Svendsen P. Involution of juvenile angiofibroma with intracranial extension. A case report with tomographic assessment. Arch Otolaryngol Head Neck Surg 1999;115:238–41.

Antoino AR, Cappiello J, Dilorenzo D, Donajo CA, Nicolai P, Orlandini A..Diagnosis, Staging and treatment of JNA. The Laryngoscope 1987;97(11):1319-25.

Levine HL, Weinstein MA, Tucker HM, Wood BG, Duchesneau PM. Diagnosis of juvenile angiofibroma by computrd tomography. Otolaryngol Head Neck Surg 1979;87:304–10.

Carrau RL, Synderman CH, Kassan AB, Jungreis CA. Endoscopic and endoscopic-assisted surgery for juvenile angiofibroma. Laryngoscope 2001;111:483–7

Mistry RC, Qureshi SS, Gupta S, Gupta S. juvenile nasopharyngeal angiofibroma: a single institution study. Indian J Cancer 2005;42:3–9.

Onerci TM, Yucel OT, Ogretmenoglu O. Endoscopic surgery in treatment of juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol 2003;67:1219–25.

Reddy KA, Mendenhall WM, Amdur RJ, Stringer SP, Cassisi NJ. Long term results of radiotherapy for juvenile nasopharyngeal angiofibroma. Am J Otolaryngol 2001;22:172–5

Jafek BW, Krekorian EA, Kirsch WM, Wood RP. Juvenile nasopharyngeal angiofibroma: management of intracranial extension. Head Neck Surg1972;2:119–28.

Brajendra,Kocker SK. Extensive fibroangioma of Nasopharynx, Report of 15 cases with literature review. Pak J Otolaryngol 1987;3:97.

Chatterji P, Soni NR. A few points in management of J Laryngol Otol 1984;98:489–92.

Conley J, Healey WV, Blaugrund SM, Erzin KH. Nasopharyngeal angiofibroma in juvenile. Surg Gynaecol Obstet 1968;126:825–37.

Downloads

Published

2015-06-20

Most read articles by the same author(s)

1 2 > >>