Role of devascularisation in surgically managed cases of juvenile nasopharyngeal angiofibroma.

Shanmuga Ashok, S (2009) Role of devascularisation in surgically managed cases of juvenile nasopharyngeal angiofibroma. Masters thesis, Madras Medical College, Chennai.


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Juvenile nasopharyngeal angiofibroma (JNA) is a benign, locally aggressive, highly vascular tumour often occurring at the superior margin of the sphenopalatine foramen occurring exclusively in adolescent males. JNA is uncommon and accounts for approximately 0.5% of all head and neck neoplasms. The median age at diagnosis is 15 years. Presenting symptoms commonly include nasal obstruction and epistaxis. Approximately 20% of patients have evidence of skull base invasion at the time of diagnosis. JNAs may be hormonally dependant. Hagen et al studied androgen receptor binding in cultured tumour fibroblasts from 3 patients with JNA and demonstrated that cell proliferation increased with testosterone and decreased with antiandrogens. Spontaneous regression is unlikely but has been observed with increasing age. The main stay of treatment of JNA is surgical excision. Preoperative role of devascularizaion is discussed. In this study , 32 cases were analysed. Nasal obstruction and epistaxis were the common symptoms noticed in almost all cases. CT scan was done in all cases . MRI and MRA was done in 7 cases. These investigations were used to accurately assess the extent of the tumour,vascular supply of the tumor and plan appropriate surgical procedure. Staging based on Radowski ‘ s system, a widely accepted and comprehensive staging system was employed. Intracranial spread was noted in three cases. Carotid angiogram with embolistion was done in ten cases. The typical capillary phase tumour blush was seen in all cases. The internal maxillary artery was the feeding vessel in all cases. One patient died following the procedure and another patient had quadriparesis. External carotid artery ligation in our opinion is a safe and effective method for decreasing blood loss during surgery. Combined with hypotensive anaesthesia provides a very good blood less field, essential for complete tumour removal the efficacy of a particular devascularisation procedure evaluated based on local control and complications. External carotid artery ligation is the best procedure in preoperative devascularisation of JNA excision. Death and cerebrovascular accident mainly in embolised ,recurrent cases.Embolisation better avoided in recurrent cases.No major complication encounterd in external carotid artery ligation,both primary aswellas recurrent cases.In our study external carotid artery ligation was the best way to devascularise the surgically managed advance cases of juvenile nasopharyngeal angiofibroma.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Devascularisation; juvenile nasopharyngeal angiofibroma
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 04 Jul 2017 06:47
Last Modified: 04 Jul 2017 06:47

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