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Newman M, Nguyen TBV, McHugh T, Reddy K, Sommer DD. Early-onset juvenile nasopharyngeal angiofibroma (JNA): a systematic review. J Otolaryngol Head Neck Surg 2023; 52:85. [PMID: 38115030 PMCID: PMC10731762 DOI: 10.1186/s40463-023-00687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Juvenile Nasopharyngeal Angiofibroma (JNA) is a fibrovascular tumor of the nasopharynx that classically presents in adolescent males. The reported mean age of onset is between 13 and 22 years old [1-6]. Significant androgen stimulation is hypothesized to explain the strong predisposition for JNA to present in young adolescent males. However, considerable variability in age at diagnosis exists with rare involvement of very young patients incongruent with typical male pubertal growth patterns. OBJECTIVE The purpose of this systematic review is to identify cases of early-onset JNA (EOJNA), (defined as age < 10 years) in the literature and to examine the disease characteristics and treatments used in this patient group. A case of a 7 year old boy with EOJNA at our institution is also described and presented. METHODS We searched Embase, Cochrane database and MEDLINE from 1996 to February 2021 for studies that reported cases of EOJNA. Relevant clinico-demographic data, disease severity and treatment outcomes were recorded and analyzed using descriptive statistics. We compared our findings with reported means for JNA in all ages. RESULTS We identified 29 studies containing a total of 34 cases of EOJNA. The vast majority (31/34) of patients were males and the mean age of diagnosis was 8.15 years old. The most common presenting symptoms were nasal obstruction (65.2%) and epistaxis (60.9%). Patients were most commonly Radkowski stage II (39.4%) and III (39.4%). Primary treatment modalities included open surgery (66.7%), endoscopic surgery (24.2%), and radiotherapy (9.1%). Recurrence was evident in 30%. Radkowski stage and type of treatment did not differ significantly within the EOJNA group (p = 0.440 and p = 0.659, respectively). CONCLUSION This systematic review suggests that rare cases of EOJNA have distinct disease characteristics. Patients in this cohort appeared to have more advanced disease and higher recurrence rates when compared with reported averages. We hope that this review prompts increased clinical awareness of this potentially more aggressive subtype of JNA. As more cases of EOJNA are reported, a more powered statistical analysis of this cohort would be feasible.
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Affiliation(s)
- Matthew Newman
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main St. West, Hamilton, ON, L8N 3Z5, Canada
| | - Thomas Boi Vu Nguyen
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main St. West, Hamilton, ON, L8N 3Z5, Canada.
| | - Tobial McHugh
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main St. West, Hamilton, ON, L8N 3Z5, Canada
| | - Kesava Reddy
- Neurological Surgery Division, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Doron Dov Sommer
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main St. West, Hamilton, ON, L8N 3Z5, Canada
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Baba A, Kurokawa R, Kurokawa M, Srinivasan A. MRI features of sinonasal tract angiofibroma/juvenile nasopharyngeal angiofibroma: Case series and systematic review. J Neuroimaging 2023; 33:675-687. [PMID: 37164909 DOI: 10.1111/jon.13116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND AND PURPOSE To comprehensively summarize the radiological characteristics of sinonasal tract angiofibroma (STA) (commonly known as juvenile nasopharyngeal angiofibroma). METHODS Forty-four lesions from 41 cases provided by 33 study articles identified through a systematic review and 13 lesions from 13 cases from our institution associated with patients with STA who underwent MRI were included in the review study, carried out by two board-certified experienced radiologists. RESULTS The study participants were all male patients with a mean age of 15.6 years at the time of diagnosis. All of them presented with nasal cavity lesions (100%), predominantly in the nasopharynx (98.2%). The sphenopalatine foramen/pterygopalatine fossa was involved in 76.0%, and compressive shift of the posterolateral wall of the maxillary sinus was present in more than half (57.9%). T2-weighted imaging signal intensity was heterogeneous with mixed high and iso intensities as compared to skeletal muscle (100%). T1-weighted imaging showed partial high signal intensity in 61.1% of the cases. Flow void and intense enhancement were present in almost all cases. Cystic/nonenhancement changes on contrast-enhanced MRI were relatively common (40.8%). The mean apparent diffusion coefficient value (2.07 × 10-3 mm2 /second) and some quantitative dynamic contrast-enhanced MRI parameters were high. There was a significant difference in the frequency of residual/recurrent lesions based on the presence of MRI findings of skull base invasion (p = .017) and intracranial extension (p = .003). CONCLUSIONS We summarized the MRI findings of STA that can facilitate timely diagnosis and appropriate management.
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Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiology, The Jikei University School of Medicine, Minato-ku, Japan
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiology, The University of Tokyo, Bunkyo-ku, Japan
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiology, The University of Tokyo, Bunkyo-ku, Japan
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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Szyfter W, Balcerowiak A, Gawęcki W, Juszkat R, Wierzbicka M. Juvenile nasopharyngeal angiofibroma-20 years of experience in endoscopic treatment. Otolaryngol Pol 2021; 75:9-14. [PMID: 33949314 DOI: 10.5604/01.3001.0014.5220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Juvenile nasopharyngeal angiofibroma is a rare, benign tumor; however, it shows local aggression and leads to profuse nosebleeds. <br/>Aim: The aim of the study is to present 20 years of experience in endoscopic treatment of this tumor. <br/>Material and methods: The material covers 71 patients treated in the years 1985-2019 at the Department of Otolaryngology and Laryngological Oncology in Poznań. In these patients, either the classic external approach, or the double approach - external with the use of endoscopes, or only the endoscopic approach was used. In the entire population, external surgeries were performed in 37 patients, double access in 8 and endoscopic access in 26 patients. <br/>Results: Complete resection of the tumor was achieved in 51 patients (72%). The remaining 20 patients (28%) had a residual or recurrent tumor and all of these patients underwent reoperation.<br/> Conclusions: The endoscopic approach with the use of various optics and navigation allows for the removal of not only small tumors but also much more advanced ones. Pre-operative evaluation of imaging results is extremely important to avoid incomplete tumor removal. Individual development of an operating strategy, a wide range of optics and various surgical methods, and especially endoscopic ones, are the guarantee of therapeutic success.
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Affiliation(s)
- Witold Szyfter
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Andrzej Balcerowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Robert Juszkat
- 2 Department of General and Procedural Radiology of the Poznan University of Medical Sciences, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
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Llorente JL, López F. The endoscopic endonasal approach for the treatment of juvenile angiofibromas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 70:136-144. [PMID: 29764608 DOI: 10.1016/j.otorri.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 01/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Juvenile angiofibroma (JA) is a benign tumour, for which the treatment of choice is surgery. It may be associated with significant morbidity because of its anatomical location and its locally destructive growth pattern. Severe haemorrhage constitutes a high risk in JA and its surgical management can be complex. The management of JA remains a challenge. The objective of this study was to review a series of patients with JA treated via the endonasal/endoscopic approach. MATERIAL AND METHODS Medical records of patients operated for JA were reviewed. MAIN OUTCOME MEASURES tumour stage, intraoperative blood loss, complications and persistence/recurrence rates. RESULTS A total of 30 male patients and one female were included. The mean age was 17 years. Using the Radkowski classification, one JA was classified as stage I, 5 stage IIA, 9 stage IIB, 4 stage IIC, 10 stage IIIA and 2 stage IIIB. Thirty-nine percent of the JA was classified as advanced stage JA (IIIA and IIIB). The mean blood loss was 1.156mL Except in one case, no significant complications were observed. Tumour persistence/recurrence was observed in 2 JA (6%), at the end of the follow-up. Mean postoperative follow-up time was 86 months. CONCLUSIONS This retrospective study supports the notion that endonasal endoscopic approaches for a JA are a feasible option associated with good long-term results.
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Affiliation(s)
- José Luis Llorente
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España.
| | - Fernando López
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
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The Endoscopic Endonasal Approach for the Treatment of Juvenile Angiofibromas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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A case of nasopharyngeal angiofibroma removed using a minimally invasive endoscopic endonasal technique. Wideochir Inne Tech Maloinwazyjne 2018; 13:551-555. [PMID: 30524630 PMCID: PMC6280076 DOI: 10.5114/wiitm.2018.75862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 04/07/2018] [Indexed: 11/17/2022] Open
Abstract
Nasopharyngeal angiofibroma is a rare head and neck tumor characterized by hypervascularity. With the development of various surgical devices and hemostatic agents, endoscopic endonasal surgery for nasopharyngeal angiofibroma, which is characterized by significant intraoperative bleeding, has become possible. We describe our experiences performing an effective endoscopic endonasal removal of a nasopharyngeal angiofibroma without embolization, using advanced devices and hemostatic agents. A 21-year-old male patient presented with massive epistaxis. The characteristic findings of angiofibroma were confirmed by computed tomography scan and nasal endoscopy. Navigation-guided endoscopic endonasal surgery was performed, and complementary devices and products were used to effectively remove the mass. Development of navigation, endoscopes, tissue handling devices, and hemostatic agents has enabled effective endoscopic endonasal removal of nasopharyngeal angiofibroma without embolization.
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Abstract
Esthesioneuroblastoma (olfactory neuroblastoma) is a rare malignant neoplasm originating from neuroepithelial cells. Treatment for this tumor has traditionally required a craniofacial resection through an external approach. The safety and efficacy of transnasal endoscopic resection is unknown. A series of five patients with Kadish stage A or B lesions of the anterior skull base were resected and immediately reconstructed endoscopically over a nine-year period. There were 2 males and 3 females with a mean age of 64 years. Three patients were treated primarily and two were treated secondarily for recurrences after failing a traditional external craniofacial resection and postoperative radiotherapy. All primary lesions received adjuvant radiotherapy. The mean follow-up time was 31 months. All patients were discharged within 4 days or less. Operative complications included temporary postoperative infraorbital anesthesia (1 patient), unplanned cerebrospinal fluid leak (1 patient), and an orbital hematoma (1 patient). None of these complications resulted in any permanent sequelae. Two patients had prolonged nasal crusting for up to one year due to a variety of factors; large cavities, radiation therapy, and exposed lyophilized dural graft. However, all skull base defects healed without any short- or long-term sequelae. There have been no local recurrences. Two patients (1 primary and 1 secondary) developed regional metastasis to the orbit or cervical lymph nodes managed with primary transorbital excision or modified neck dissection, respectively. All but one patient remain free of disease by clinical, endoscopic, and radiographic (CT or MRI) surveillance. The remaining patient recurred distally as an undifferentiated carcinoma in his temporal bone and lungs 12 months after the initial resection. In experienced hands select cases of esthesioneuroblastoma can be safely excised and reconstructed endoscopically with comparable degrees of tissue removal as with external approaches. Short-term oncologic results in this small series of patients appear to be comparable to traditional methods. Longer follow-up on a larger series of patients is warranted.
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Affiliation(s)
- Roy R. Casiano
- Department of Otolaryngology, University of Miami School of Medicine, Miami, Florida
| | - William A. Numa
- Department of Otolaryngology, University of Miami School of Medicine, Miami, Florida
| | - Alberto M. Falquez
- Department of Otolaryngology, University of Miami School of Medicine, Miami, Florida
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Safadi A, Schreiber A, Fliss DM, Nicolai P. Juvenile Angiofibroma: Current Management Strategies. J Neurol Surg B Skull Base 2018; 79:21-30. [PMID: 29404237 DOI: 10.1055/s-0037-1615810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Juvenile angiofibroma (JA) is a benign, highly vascular tumor which is diagnosed on the basis of clinical and imaging features. It has a characteristic pattern of spread commonly involving the pterygopalatine fossa and pterygoid base. The mainstay of treatment is surgery, while radiotherapy is rarely used for the treatment of recurrent lesion. Endoscopic endonasal surgery is currently the treatment of choice for small to intermediate size JAs, and is feasible even for advanced lesions; however, this should only be practiced in well-experienced centers.
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Affiliation(s)
- Ahmad Safadi
- Department of Otorhinolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alberto Schreiber
- Department of Otorhinolaryngology - Head and Neck Surgery, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Dan M Fliss
- Department of Otorhinolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
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López F, Triantafyllou A, Snyderman CH, Hunt JL, Suárez C, Lund VJ, Strojan P, Saba NF, Nixon IJ, Devaney KO, Alobid I, Bernal-Sprekelsen M, Hanna EY, Rinaldo A, Ferlito A. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head Neck 2017; 39:1033-1045. [PMID: 28199045 DOI: 10.1002/hed.24696] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/03/2016] [Accepted: 12/06/2016] [Indexed: 12/12/2022] Open
Abstract
Juvenile angiofibroma is an uncommon, benign, locally aggressive vascular tumor. It is found almost exclusively in young men. Common presenting symptoms include nasal obstruction and epistaxis. More advanced tumors may present with facial swelling and visual or neurological disturbances. The evaluation of patients with juvenile angiofibroma relies on diagnostic imaging. Preoperative biopsy is not recommended. The mainstay of treatment is resection combined with preoperative embolization. Endoscopic surgery is the approach of choice in early stages, whereas, in advanced stages, open or endoscopic approaches are feasible in expert hands. Postoperative radiotherapy (RT) or stereotactic radiosurgery seem valuable in long-term control of juvenile angiofibroma, particularly those that extend to anatomically critical areas unsuitable for complete resection. Chemotherapy and hormone therapy are ineffective. The purpose of the present review was to update current aspects of knowledge related to this rare and challenging disease. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1033-1045, 2017.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, Spain
| | - Asterios Triantafyllou
- Pathology Department, Liverpool Clinical Laboratories, Liverpool, UK.,School of Dentistry, University of Liverpool, Liverpool, UK
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Carlos Suárez
- Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, Spain
| | - Valerie J Lund
- Professorial Unit, Ear Institute, University College London, London, UK
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Iain J Nixon
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK
| | | | - Isam Alobid
- Department of Otolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Department of Otolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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Khoueir N, Nicolas N, Rohayem Z, Haddad A, Abou Hamad W. Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma. Otolaryngol Head Neck Surg 2013; 150:350-8. [DOI: 10.1177/0194599813516605] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications. Data Sources Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles. Review Methods The literature was searched by 2 reviewers with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. We were only able to perform a meta-analysis on the categorical outcomes using DerSimonian and Laird random effects models. Results Ninety-two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (minimum, 20 mL; maximum, 1482 mL). It was 414.6 mL (minimum, 20 mL; maximum, 1000 mL) and 774.2 mL (minimum, 228 mL; maximum, 1482 mL), respectively, in the group with and without embolization. No conclusion could be made because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval [CI], 8.3-11.7). It was 9.3% (95% CI, 7.2-11.5) for complications and 7.7% (95% CI, 5.4-10.1) for residual tumor. Conclusion The endoscopic treatment is an evolving modality. It is considered today the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.
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Affiliation(s)
- Nadim Khoueir
- Otolaryngology–Head and Neck Surgery, Hotel Dieu de France University Hospital, Saint Joseph University Medical School, Beirut, Lebanon
| | - Nicolas Nicolas
- Otolaryngology–Head and Neck Surgery, Hotel Dieu de France University Hospital, Saint Joseph University Medical School, Beirut, Lebanon
| | - Ziad Rohayem
- Otolaryngology–Head and Neck Surgery, Saint-Elizabeth Medical Center, Brighton, Massachusetts, USA
| | - Amine Haddad
- Otolaryngology–Head and Neck Surgery, Hotel Dieu de France University Hospital, Saint Joseph University Medical School, Beirut, Lebanon
| | - Walid Abou Hamad
- Otolaryngology–Head and Neck Surgery, Hotel Dieu de France University Hospital, Saint Joseph University Medical School, Beirut, Lebanon
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Boghani Z, Husain Q, Kanumuri VV, Khan MN, Sangvhi S, Liu JK, Eloy JA. Juvenile nasopharyngeal angiofibroma: A Systematic Review and Comparison of Endoscopic, Endoscopic-Assisted, and Open Resection in 1047 Cases. Laryngoscope 2013; 123:859-69. [DOI: 10.1002/lary.23843] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/12/2012] [Accepted: 10/03/2012] [Indexed: 11/07/2022]
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Harvey RJ, Winder M, Parmar P, Lund V. Endoscopic skull base surgery for sinonasal malignancy. Otolaryngol Clin North Am 2012; 44:1081-140. [PMID: 21978897 DOI: 10.1016/j.otc.2011.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Management of malignant neoplasms of the sinonasal tract and skull base is hampered by the relative low incidence and pathologic diversity of patient presentations. Many studies have reported successful outcomes in the endoscopic management of malignancy since 1996, and these are summarized in this article. Nonsurgical adjuvant therapies are important for locoregional control because surgery occurs in a restricted anatomic space with close margins to critical structures, and distant disease is an ongoing concern in these disorders. There remains a need for collaborative consistent multicenter reporting, and international registries have been established to assist in such efforts.
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Affiliation(s)
- Richard J Harvey
- Department of Otolaryngology/Skull Base Surgery, St Vincent's Hospital, Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
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Abstract
Juvenile angiofibroma is a rare benign lesion originating from the pterygopalatine fossa with distinctive epidemiologic features and growth patterns. The typical patient is an adolescent male with a clinical history of recurrent epistaxis and nasal obstruction. Although the use of nonsurgical therapies is described in the literature, surgery is currently considered the ideal treatment for juvenile angiofibroma. Refinement in preoperative embolization has provided significant reduction of complications and intraoperative bleeding with minimal risk of residual disease. During the last decade, an endoscopic technique has been extensively adopted as a valid alternative to external approaches in the management of small-intermediate size juvenile angiofibromas. Herein, we review the evolution in the management of juvenile angiofibroma with particular reference to recent advances in diagnosis and treatment.
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Fonseca AS, Vinhaes E, Boaventura V, de Andrade NA, Dias LA, Medeiros V, Coifman F. Surgical Treatment of Non-embolized Patients with Nasoangiofibroma. Braz J Otorhinolaryngol 2008; 74:583-7. [PMID: 18852986 PMCID: PMC9442087 DOI: 10.1016/s1808-8694(15)30607-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 09/12/2007] [Indexed: 11/25/2022] Open
Abstract
Materials And Method Results Conclusion
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Endoscopic approach to juvenile nasopharyngeal angiofibroma: our experience at a tertiary care centre. The Journal of Laryngology & Otology 2008; 122:1185-9. [DOI: 10.1017/s002221510700148x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To evaluate the efficacy of endoscopic exposure and excision for juvenile nasopharyngeal angiofibroma.Design:Prospective analysis of the outcomes of endoscopic removal of the angiofibroma at a tertiary care centre, using endoscopic and radiological parameters.Subjects:Twenty-eight consecutive patients with angiofibroma were included. These patients underwent endonasal endoscopic excision of the lesion, following pre-operative computed tomography and digital subtraction angiography. Post-operative endoscopy and radiology were performed at six weeks to detect any residual lesion, and thereafter at six-monthly intervals to detect recurrence.Results:Twenty-one patients (75 per cent) were new cases and seven patients (25 per cent) had recurrent tumour. Pre-operative embolisation was performed in 21 patients (75 per cent). An endoscopic endonasal approach was used to access the pterygopalatine fossa. The average blood loss was 228 ml. Residual lesion was noted in one patient (initially with recurrent stage II C pathology). The remaining 27 patients (initially with stage I, II A and II B pathology) were free of residual pathology or recurrence after a minimum follow-up period of 12 months.Conclusion:Endoscopic exposure and excision of angiofibroma was found to be effective.
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Castro A, Lassaletta L, Bastarrica M, Prim MP, De Sarriá MJ, Gavilán J. Comparison of different mobile telephones in Combi40+ users. Acta Otolaryngol 2006; 126:714-7. [PMID: 16803710 DOI: 10.1080/00016480500469552] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSION Telephone usage is a difficult challenge for cochlear implanted patients. A significant number of cochlear implanted patients are able to carry on a land-line or mobile telephone conversation. The telephone model may be a critical factor for telephone performance. OBJECTIVES The goals of this study were to evaluate speech discrimination through land-line and mobile telephones in Combi40+ users, and to compare different mobile telephone models to find out which could be more advisable for them. PATIENTS AND METHODS Eighteen Combi40+ implantees were tested with CID sentences and bisyllabic words presented through land-line and mobile telephones, in both quiet and noisy environments. RESULTS Mean scores for telephonic speech discrimination were over 85% for CID sentences and 28-59% for bisyllabic words. The Siemens M55 was superior to the other mobile telephones tested.
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Affiliation(s)
- A Castro
- Department of Oto-rhino-laryngology, La Paz University Hospital, Madrid, Spain.
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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. [PMID: 16432402 DOI: 10.1097/01.scs.0000193555.24670.4c] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study presents a comparative analysis of current surgical approaches for the treatment of nasopharyngeal angiofibroma, including extension of tumors, postoperative morbidity, complications, and recurrence rate. Twenty-four patients who underwent surgery with the diagnosis of juvenile nasopharyngeal angiofibroma at our department between 1993 and 2003 were retrospectively reviewed according to their clinical presentation, surgical approaches, and prognosis. Radkowski staging scale was used for staging tumors. The transpalatal approach was used in 10 patients before 1999 with tumor stages between Ia and IIa. Transpalatal fistula was encountered in one. Nine patients underwent transnasal endoscopic surgery after 1999 with tumor stages between Ia and IIIa. Lateral rhinotomy in four patients and a degloving approach in one patient were used with tumor stages between IIa and IIIa; postoperative nasal crusting was the most annoying problem in these groups. Recurrent tumor was seen in only one patient who had undergone the transpalatal approach in the 12- to 56-month follow-up period. In this regard, the transnasal endoscopic approach can be used successfully in place of the transpalatal approach due to the former's lesser surgical morbidity and wide lateral exposure of the field in patients with nasopharyngeal angiofibroma. Also, many patients who underwent lateral rhinotomy for the removal of stage IIa, IIb, and IIIa tumors can successfully be treated using the transnasal endoscopic approach. In tumors that extend, infratemporal fossa lateral rhinotomy and degloving approaches provide the optimal exposure but have higher potential for morbidity than does transnasal endoscopic surgery.
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Affiliation(s)
- Fuat Tosun
- Department of Otorhinolaryngology and Head Neck Surgery, Gülhane Military Medical School, Etlik, Ankara, Turkey.
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Douglas R, Wormald PJ. Endoscopic surgery for juvenile nasopharyngeal angiofibroma: where are the limits? Curr Opin Otolaryngol Head Neck Surg 2006; 14:1-5. [PMID: 16467630 DOI: 10.1097/01.moo.0000188859.91607.65] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article will examine recent publications on the endoscopic management of juvenile nasopharyngeal angiofibromas. RECENT FINDINGS The use of an endoscopic approach to resect small juvenile nasopharyngeal angiofibromas is supported by excellent results from a number of operative series published in recent years. Large juvenile nasopharyngeal angiofibromas continue to present a considerable surgical challenge, with most being resected by traditional open approaches. However, the results achieved after the endoscopic resection of large tumours have been reported for a small number of cases. This review focuses on the outcome of these cases, which would seem to compare favourably to open series, and the advances in instrumentation and techniques, that facilitate the endoscopic removal of large juvenile nasopharyngeal angiofibromas. SUMMARY Improvements in preoperative assessment and preparation, operative technique, and instrumentation potentially enable the endoscopic removal of most juvenile nasopharyngeal angiofibromas.
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Affiliation(s)
- Richard Douglas
- Department of Otolaryngology-Head and Neck Surgery, The Queen Elizabeth Hospital, Woodville, Australia
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Adams JS, Hasenstab MS, Pippin GW, Sismanis A. Telephone Use and Understanding in Patients with Cochlear Implants. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408300210] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a mail survey of patients who had received cochlear implants to ascertain their ability to communicate on the telephone. Of 86 patients who responded, 38 (44%) did not use the telephone at all, 36 (42%) were able to use the telephone without assistance (independent users), and 12 (14%) were able to use the telephone with some type of assistance. Factors associated with independent use were male sex, older age at the onset of hearing loss, longer duration of hearing loss, successful use of hearing aids prior to cochlear implantation, implantation with a MED-EL Combi 40+ device, and a shorter duration of implant use. But regardless of circumstances, our findings suggest that many cochlear implant patients can use the telephone during daily activity without the need for assistive devices or relay services.
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Affiliation(s)
- Jeffrey S. Adams
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Virginia Hospitals and Physicians, Richmond
| | - M. Suzanne Hasenstab
- Audiology Center Virginia Commonwealth University Health Systems, Medical College of Virginia Hospitals and Physicians, Richmond
| | - Gregory W. Pippin
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Virginia Hospitals and Physicians, Richmond
| | - Aristides Sismanis
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Virginia Hospitals and Physicians, Richmond
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Wormald JP, Van Hasselt A. Endoscopic Removal of Juvenile Angiofibromas. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND: Angiofibromas have traditionally been removed through open procedures. All tumors in this consecutive series of patients were removed endoscopically.
SETTING: Tertiary care hospital.
MATERIALS AND METHODS: Seven consecutive patients presenting with an angiofibroma between 1994 and 2000 were included in the study. Tumor size varied with 1 stage 1, 2 stage IIa, 3 stage IIb, and 1 stage IIC according to the Radkowski et al classification. The surgical technique is presented.
RESULTS: After an average of 3.75 years (SD, 1.9 years), there have been no tumor recurrences.
CONCLUSION: Endoscopic removal of angiofibromas in the nasal cavity, with extension into the sinuses and pterygopalatine fossa and with limited extension into the infratemporal fossa, can be removed endoscopically with a good success rate. (Otolaryngol Head Neck Surg 2003;129:684-91.)
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Affiliation(s)
- John Peter Wormald
- Adelaide, Australia, and Hong Kong, China
- Departments of Surgery, Otolaryngology–Head and Neck Surgery, Adelaide and Flinders Universities
| | - Andrew Van Hasselt
- Adelaide, Australia, and Hong Kong, China
- Chinese University of Hong Kong
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Nicolai P, Berlucchi M, Tomenzoli D, Cappiello J, Trimarchi M, Maroldi R, Battaglia G, Antonelli AR. Endoscopic surgery for juvenile angiofibroma: when and how. Laryngoscope 2003; 113:775-82. [PMID: 12792310 DOI: 10.1097/00005537-200305000-00003] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS In recent years, the indications for endoscopic surgery of the sinonasal tract, originally introduced for the treatment of inflammatory diseases, have been expanded to include selected cases of benign and malignant neoplastic lesions. The aim of the present study was to establish the efficacy of endoscopic surgery in the management of small and intermediate-sized juvenile angiofibromas. STUDY DESIGN Retrospective study. METHODS We reviewed the clinical records and the preoperative and postoperative imaging studies of 15 patients with juvenile angiofibroma who were treated with an endoscopic approach after embolization in the period from January 1994 to April 2000. All patients were prospectively followed by endoscopic and magnetic resonance imaging evaluations performed at regular intervals (every 4 months during the first year and, subsequently, every 6 months). RESULTS According to a staging system reported in 1989, there were two patients with a type I, nine with a type II, three with a type IIIA, and one with a type IIIB juvenile angiofibroma. Angiography demonstrated that the vascular supply was strictly unilateral in 11 patients and bilateral in 4. Intraoperative blood loss ranged from 80 to 600 mL (mean blood loss, 372 mL). During follow-up (range, 24-93 mo; mean follow-up, 50 mo [SD +/- 19.9 mo]), only one patient presented a residual lesion on magnetic resonance imaging, which was 16 mm in diameter and was detected 24 months after surgery. CONCLUSIONS The endoscopic approach is a safe and effective technique that allows removal of small and intermediate-sized juvenile angiofibromas (without extensive involvement of the infratemporal fossa and cavernous sinus) with a low morbidity. Advanced lesions are more appropriately treated by external approaches.
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Affiliation(s)
- Piero Nicolai
- Department of Otorhinolaryngology, University of Brescia, Italy
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Naraghi M, Kashfi A. Endoscopic resection of nasopharyngeal angiofibromas by combined transnasal and transoral routes. Am J Otolaryngol 2003; 24:149-54. [PMID: 12761700 DOI: 10.1016/s0196-0709(02)32402-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the role of endoscopic surgery in decreasing intraoperative bleeding, morbidity, and hospitalization period of juvenile nasopharyngeal angiofibroma resection and to describe combined endoscopic transnasal and transoral approaches. PATIENTS AND METHODS Twelve cases of juvenile nasopharyngeal angiofibroma diagnosed by endoscopic examination, computed tomography, and angiography were selected for endoscopic resection. Tumor staging ranged from stage I(A) to II(B). Ten patients underwent preoperative selective arterial embolization, and in 1 case selective arterial ligation was used. In general, the tumors were approached endoscopically through nasal and oral cavities with 0 degrees and 30 degrees 4-mm telescopes without any incision and no packing at their termination. RESULTS The patients were followed by endoscopy and computed tomography. There was a dramatic decrease in intraoperative bleeding and postoperative morbidity. No early postoperative complications were seen. Two recurrences were observed in 12 patients up to a mean follow-up of 15 months. CONCLUSIONS Minimal bleeding, decreased morbidity, and shorter hospitalization period were the main reasons that prompted us to use endoscopic technique for the removal of juvenile nasopharyngeal angiofibroma. Adding transoral endoscopic approach to the transnasal endoscopic approach provides 2-sided exposure and appreciate access to angiofibroma.
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Affiliation(s)
- Mohsen Naraghi
- Department of Otolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
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Baradaranfar MH, Moghaddam PD. Transnasal endoscopic surgery for resection of angiofibroma with and without arterial embolization. Ann Saudi Med 2003; 23:67-8. [PMID: 17146230 DOI: 10.5144/0256-4947.2003.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mohammad Hossein Baradaranfar
- Departments of Otolaryngology, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran and Yazs University of Medical Sciences, Yazd Iran,
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Forer B, Derowe A, Cohen JT, Landsberg R, Gil Z, Fliss DM. Surgical approaches to juvenile nasopharyngeal angiofibroma. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s1043-1810(01)80024-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Scholtz AW, Appenroth E, Kammen-Jolly K, Scholtz LU, Thumfart WF. Juvenile nasopharyngeal angiofibroma: management and therapy. Laryngoscope 2001; 111:681-7. [PMID: 11359140 DOI: 10.1097/00005537-200104000-00022] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To conduct a review of contemporary approaches on the diagnostic-preoperative, operative, and postoperative methods in the management of juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN Retrospective study of 14 cases of JNA resection at the Department of Otorhinolaryngology, University of Innsbruck (Innsbruck, Austria) between 1987 and 1998. METHODS Data was obtained for each patient regarding age, presenting symptoms, duration of symptoms, biopsy findings, tumor location, administration of preoperative angiography and embolization, and surgical approach. The follow-up period ranged from 1 to 13 years. RESULTS Based on the histological evaluation by the preoperative biopsy and the tumor location, several surgical approaches were applied. A transnasal endoscopic procedure was employed in seven cases. The preoperative embolization and the intranasal approach with the potassium titanyl phosphate laser minimized blood loss. The recurrence rate was at a low of 15%. CONCLUSION The surgical approach should be determined by tumor location, tumor size, and effectiveness of tumor embolization. For patients with JNA with tumor extension involving the nasopharynx, the nasal cavity, the paranasal sinuses, and the pterygopalatine fossa, the transnasal endoscopic technique offers a minimally invasive resection of the entire tumor mass with minimal morphological disturbance.
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Affiliation(s)
- A W Scholtz
- Department of Otorhinolaryngology, University of Innsbruck, Innsbruck, Austria
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Carrau RL, Snyderman CH, Kassam AB, Jungreis CA. Endoscopic and endoscopic-assisted surgery for juvenile angiofibroma. Laryngoscope 2001; 111:483-7. [PMID: 11224780 DOI: 10.1097/00005537-200103000-00019] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The mainstay treatment for juvenile angiofibromas is surgery. Endoscopic techniques have been applied to the resection of juvenile angiofibromas. The aim of the study is to establish the efficacy of endoscopic and endoscopic-assisted techniques for the removal of juvenile angiofibromas. STUDY DESIGN Retrospective review. METHODS Retrospective review was made of all patients with juvenile angiofibromas who were treated with endoscopic and endoscopic-assisted surgery from January 1994 to July 1999. RESULTS Fifteen tumors in 13 patients were removed using endoscopic or endoscopic-assisted surgeries. In 11 patients, endoscopic surgery or endoscopic-assisted surgery (or both) was successful and the patients remained without evidence of disease at a median follow-up of 34 months. In two patients tumor persisted, which was detected during routine follow-up less than 6 months after the initial surgery. These tumors were managed with a second endoscopic or endoscopic-assisted surgery, and patients remained without evidence of disease. We encountered one postoperative complication, a progressive optic neuropathy that was successfully managed with endoscopic decompression. CONCLUSIONS Endoscopic and endoscopic-assisted surgery is a feasible alternative or adjunct to traditional techniques.
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Affiliation(s)
- R L Carrau
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, U.S.A
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Transnasal endoscopic surgery for benign neoplasms of the nose and sinuses. Curr Opin Otolaryngol Head Neck Surg 2001. [DOI: 10.1097/00020840-200102000-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Newlands SD, Weymuller EA. Endoscopic treatment of juvenile nasopharyngeal angiofibroma. AMERICAN JOURNAL OF RHINOLOGY 1999; 13:213-9. [PMID: 10392241 DOI: 10.2500/105065899781389812] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Traditional treatment of juvenile nasopharyngeal angiofibromas (JNAs) has included open surgical approaches for the majority of tumors. At the University of Washington Medical Center (UWMC), endoscopic techniques have been used for the removal of some small JNAs. This report describes the institutional experience in treating these tumors. The medical records of 15 patients at UWMC treated over a 15-year period for JNA were reviewed. Three patients were treated only by an endoscopic approach, and one patient had a combined endoscopic and open procedure. All three of the patients treated only by the endoscopic approach were disease free with a minimum of 24 months follow up. The one patient treated with a combined endoscopic and open approach had recurrence of disease. Endoscopic removal after embolization effectively treated three patients with early stage JNAs. Indications for this procedure are discussed.
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Affiliation(s)
- S D Newlands
- Department of Surgery, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Herman P, Lot G, Chapot R, Salvan D, Huy PT. Long-term follow-up of juvenile nasopharyngeal angiofibromas: analysis of recurrences. Laryngoscope 1999; 109:140-7. [PMID: 9917056 DOI: 10.1097/00005537-199901000-00027] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Juvenile nasopharyngeal angiofibroma often recurs if the tumor is large. This report is a long-term follow-up of these cases. It establishes the prognostic values of tumor extensions, analyzes the anatomic factors involved in recurrences, describes the spontaneous evolution of remnants based on a radiographic follow-up, and evaluates the pertinence of complex combined surgical approaches for invasive tumors and the value of complementary endoscopy. STUDY DESIGN Retrospective review of 44 cases treated between 1985 and 1996. METHODS Statistical analysis of the correlation between recurrence and tumor extension as evaluated by systematic analysis of 18 putative tumor extensions on preoperative computed tomography scans. RESULTS Invasion of the skull base affected two-thirds of the patients, and the rate of recurrence was 27.5%. Extensions to the infratemporal fossa, sphenoid sinus, base of pterygoids and clivus, the cavernous sinus (medial), foramen lacerum, and anterior fossa were correlated with more frequent recurrence. Long-term radiographic follow-up revealed putative residual disease in nine asymptomatic patients: these remnants gradually involuted. CONCLUSIONS The data in the current study emphasize the prognostic value of skull base invasion and the difficulty of complete resection of extended lesions. Tumor remnants detected in symptom-free patients should be kept under surveillance by repeated computed tomography scan, since involution may occur. Recurrent symptoms may be treated by radiotherapy (30 Gy) rather than by extended combined procedures. Endoscopic surgery should be combined with surgery for better control of skull base extensions.
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Affiliation(s)
- P Herman
- Department of Ear, Nose, and Throat Medicine, Hôpital Lariboisière, Paris, France
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