Surgical approaches for juvenile nasopharyngeal angiofibroma - Spectrum analysis

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Produl Hazarika

NMC Specialty Hospital, UAE

: J Otol Rhinol

Abstract

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Juvenile nasopharyngeal angiofibroma (JNA) is a very rare benign vascular tumor, occurs, only in adolescent male. 0.5% of all head & neck tumors are JNA. Presenting symptoms of this tumor are profuse, painless, unprovoked, recurrent nasal bleeding. Nasal obstruction in early cases but myriad of symptoms of facial swelling, proptosis and other neurological symptoms may be seen in late cases. JNA though originally arises from nasopharynx also is very much known for its extension to the different parts of the nose, skull base and intracranial spaces, causing both diagnostic and therapeutic problem for the practicing otolaryngologist. Common clinical presentation of these tumors is nasal obstruction in 80 to 90% followed by recurrent, painless, profuse and unprovoked epistaxis in 45 to 60% of the cases. Radiological investigations included are contrast Ct scan, MRI scan, angiography to find the feeding vessel. Surgical removal of the tumor is the only definitive line of treatment. However, various surgical approaches may be needed depending on its extension and vascular supply. This paper deals with 33 cases of JNA with or without extra nasopharyngeal extension where ten different surgical approaches have been adopted for tumor excision. Logic of application and advantages of surgical procedure in each case of angiofibroma will be highlighted and will be demonstrated in video clip. Newer approaches like endoscopic and Le forte osteotomy will be discussed more in details. Recurrence after surgery, avoidance and treatment will also be discussed.

Biography

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Produl Hazarika is presently working as an Otolaryngologist in NMC Specialty Hospital in Abu Dhabi, UAE. He is a former Professor, Head and Director of Postgraduate studies of the Department of Otorhinolaryngology and Head & Neck Surgery at Kasturba Medical College, Manipal, India. He has 28 years of clinical teaching experience both at undergraduate and postgraduate levels, with over 100 publications in various national and international journals. He was selected as international guest scholar by the American College of Surgeon in 1986 and has travelled widely to the US, Australia, UK and Malaysia, Switzerland, Mauritius for various fellowship programs.