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Endoscopic Excision of Non-embolized Juvenile Nasopharyngeal Angiofibroma: Our Technique

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Abstract

To approach Juvenile nasopharyngeal angiofibroma extending to the sphenoid sinus, pterygoid wedge and minimal involvement of the pterygopalatine fossa (Radkowski Stage 2 A) with an endoscopic technique without embolization with no recurrence and minimal morbidity and mortality. This is a retrospective, descriptive study based on the medical records of 15 patients with histologically confirmed JNA who underwent endoscopic binostril four handed endoscopic excision in our centre without embolisation between 2010 and 2015. All 15 patients were young males with a mean age of 14.13 years who underwent endoscopic excision of JNA without embolisation. Nasal obstruction (100 %) and epistaxis (100 %) were the most common symptoms. Average surgery length was 1 h 41 min. Mean blood loss was 67.2 ml and none of patients required blood transfusion. All patients had crusting and septal defect postoperatively, only 3 (20 %) had synechiae. Mean hospitalization time was 3.66 days. 2 (13.33 %) of our patients had a residual tumor and one (6.66 %) had a relapse in pterygoid wedge. There were no cases of death or significant morbidity. The follow up period was 1 year. Endoscopic endo nasal bi nostril four handed technique can achieve complete resection without embolization in case of small to medium sized JNA s in the hands of an experienced surgeon with minimal blood loss, low rates of recurrence and morbidity.

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References

  1. Nicolai P, Berlucchi M, Tomenzoli D et al (2003) Endoscopic surgery for juvenile angiofibroma: when and how. Laryngoscope 113(5):775–782

    Article  PubMed  Google Scholar 

  2. Joo D, Chhetri DK, Wang MB (2008) Endoscopic removal of juvenile nasopharyngeal angiofibromas: a video presentation. Laryngoscope 118(6):e1–e3

    Article  PubMed  Google Scholar 

  3. Douglas R, Wormald PJ (2006) Endoscopic surgery for juvenile nasopharyngeal angiofibroma: where are the limits? Curr Opin Otolaryngol Head Neck Surg 14(1):1–5

    Article  PubMed  Google Scholar 

  4. Ardehali MM, Samimi Ardestani SH, Yazdani N, Goodarzi H, Bastaninejad S (2010) Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma: complications and outcomes. Am J Otolaryngol 31(5):343–349

    Article  PubMed  Google Scholar 

  5. Mehmet A, Orhan S, Suphi M (2006) Juvenile nasopharyngeal angiofibroma: radiological evaluation and pre-operative embolization. KBB Forum 5:58–61

    Google Scholar 

  6. Borghei P, Baradaranfar MH, Borghei SH, Sokhandon F (2006) Transnasal endoscopic resection of juvenile nasopharyngeal angiofibroma without preoperative embolization. Ear Nose Throat J 85:740–743

    PubMed  Google Scholar 

  7. Chaveau C (1906) Histoire des maladies du Pharynx. Balliere, Paris

    Google Scholar 

  8. Andrade NA, Pinto JA, Nóbrega MO et al (2007) Exclusively endoscopic surgery for juvenile nasopharyngeal angiofibroma. Otolaryngol Head Neck Surg 137(3):492–496

    Article  PubMed  Google Scholar 

  9. Salim Y, İsmail U, Mansur D et al (2013) A giant juvenile nasopharyngeal angiofibroma. J Craniofac Surg 24(3):e207–e209

    Google Scholar 

  10. Wormald PJ (2005) Endoscopic medial maxillectomy for maxillary and pterygopalatine fossa tumors. In: Wormold PJ (ed) Endoscopic Sinus Surgery: anatomy, three dimensional reconstruction, and surgical technique (1st ed), Thieme, New York, pp 125–134

  11. Katsiotis P, Tzortzis G, Karaminis C (1979) Transcatheter arterial embolization in nasopharyngeal angiofibroma. Acta Radiol Diagn (Stockh) 20(3):433–438

    CAS  Google Scholar 

  12. Roger G, Huy PT, Froehlich P et al (2002) Exclusively endoscopic removal of juvenile nasopharyngeal angiofibroma: trends and limits. Arch Otolaryngol Head Neck Surg 128(8):928–935

    Article  PubMed  Google Scholar 

  13. Strong EB, Bell DA, Johnson LP et al (1995) Intractable epistaxis: transantral ligation vs. embolization efficacy review and cost analysis. Otolaryngol Head Neck Surg 113(6):674–678

    Article  CAS  PubMed  Google Scholar 

  14. Fonseca AS, Vinhaes E, Boaventura V et al (2008) Surgical treatment of non- embolised patients with nasoangiofibroma. Braz J Otorhinolaryngol 74(4):583–587

    Article  PubMed  Google Scholar 

  15. Moulin G, Chagnaud C, Gras R et al (1995) Juvenile nasopharyngeal angiofibroma: comparison of blood loss during removal in embolized group versus nonembolized group. Cardiovasc Intervent Radiol 18(3):158–161

    CAS  PubMed  Google Scholar 

  16. Petruson K, Catarino MR, Petrusin B (2002) Juvenile nasopharyngeal angiofibroma: long-term results in preoperative embolized and nonembolized patients. Acta Otolaryngol 122(1):96–100

    Article  PubMed  Google Scholar 

  17. Pletcher JD, Newton TH, Dedo HH (1975) Preoperative embolization of juvenile angiofibromas of the nasopharynx. Ann Otol Rhinol Laryngol 84(6):740–746

    Article  CAS  PubMed  Google Scholar 

  18. Terzian AE (2000) Juvenile nasopharyngeal angiofibroma—transantral microsurgical approach. In: Stamm AC, Draf W(eds) Micro-endoscopic surgery of the paranasal sinuses and the skull Base. Chapter 42, Springer, Berlin, Heidelberg, pp 515–528

  19. Pryor S, Moore E, Kasperbauer J (2005) Endoscopic vs traditional approaches for excision of juvenile nasopharyngeal angiofibroma. Laryngoscope 115:1201–1207

    Article  PubMed  Google Scholar 

  20. Ardehali MM, Samimi SH, Bakhshaee M (2014) An effective technique for endoscopic resection of advanced stage angiofibroma. Iran J Otorhinolaryngol 26(74):25–30

    Google Scholar 

  21. Herman P, Lot G, Chapot R et al (1999) Long-term follow-up of juvenile nasopharyngeal angiofibromas: analysis of recurrences. Laryngoscope 109:140–147

    Article  CAS  PubMed  Google Scholar 

  22. Gullane PJ, Davidson J, O’Dwyer T, Forte V (1992) Juvenile angiofibroma: a review of the literature and a case series report. Laryngoscope 102(8):928–933

    Article  CAS  PubMed  Google Scholar 

  23. Jorissen M, Eloy P, Rombaux P et al (2000) Endoscopic sinus surgery for juvenile nasopharyngeal angiofibroma. Acta Otorhinolaryngol Belg 54(2):201–219

    CAS  PubMed  Google Scholar 

  24. Howard DJ, Lloyd G, Lund V (2001) Recurrence and its avoidance in juvenile angiofibroma. Laryngoscope 111(9):1509–1511

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Royal Pearl Hospital, Tiruchirapalli, Tamilnadu, India

    Trichy Narayanan Janakiram, Shilpee Bhatia Sharma & Vidya Bhargavan Panicker

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  1. Trichy Narayanan Janakiram
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  2. Shilpee Bhatia Sharma
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  3. Vidya Bhargavan Panicker
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Correspondence to Trichy Narayanan Janakiram.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Janakiram, T.N., Sharma, S.B. & Panicker, V.B. Endoscopic Excision of Non-embolized Juvenile Nasopharyngeal Angiofibroma: Our Technique. Indian J Otolaryngol Head Neck Surg 68, 263–269 (2016). https://doi.org/10.1007/s12070-016-1013-1

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  • DOI: https://doi.org/10.1007/s12070-016-1013-1

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