Resumen. LESCAILLE TORRES, Juan Gualberto. Juvenile nasopharyngeal angiofibroma. Rev Cubana Med Gen Integr [online]. , vol, n.2, pp. PDF | On Apr 2, , Luis Fernando Padilla and others published Angiofibroma nasofaríngeo juvenil: serie de casos del Hospital Universitario. Download Citation on ResearchGate | Angiofibroma nasofaríngeo juvenil: A propósito de un caso | A Caucasian year old boy presenting a relative health .
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Juvenile nasopharyngeal angiofibroma NAJ is a tumor with vascular component, slow growing, benign but very aggressive because of its local invasiveness.
The NAJ is rare, accounting for 0. The classic triad of epistaxis, unilateral nasal obstruction and a mass in the nasopharynx suggests the diagnosis of NAJ and is then supplemented by imaging. Over the past 10 years the treatment of this disease has been discussed with the aim of designing a management protocol.
Currently, surgery appears to be the best treatment of the NAJ. Other methods such as hormone therapy, radiotherapy and chemotherapy treatment modalities are now used occasionally as complementary treatments.
To present the cases of this disease in the Hospital Infantil between October and August A retrospective case study of five cases of NAJ underwent surgery solely with endoscopic technique of two surgeons. All patients underwent angiography with embolization of the tumor days before surgery.
Angiofibroma nasofaríngeo juvenil – Wikipedia, la enciclopedia libre
Follow-up after surgery to detect recurrence. There were two relapses in the following two years after surgery. Given the short period of patient follow-up, there were only two relapses in one year. So there is need for further action to claim that this technique has a low recurrence rate, since the recurrence is probably related to incomplete resection the initial tumor.
Endoscopic Surgery of Nasopharyngeal Angiofibroma. Other names have been used as a nasopharyngeal fibroma, fibroma of the adolescent and bleeding fibroangioma 1.
The juvenile nasopharyngeal angiofibroma NAJ is a tumor with vascular component, slow growing, benign but very aggressive because of its local invasiveness 2,3,4,5,6,7,8. Occurs almost entirely pre-adolescent and adolescent males, perhaps to respond to androgens 2,3,4,5,9.
The pathogenesis remains controversial, but some theories have been proposed, such as congenital theory, the hormonal, vascular and genetic 2,3, The genetic alterations observed more often involve sex chromosomes. Numerous growth factors seem to be implicated in the pathogenesis of tumor.
Another recent study of Schlauder et al suggests that the enzyme aromatase is responsible for local conversion of androgens to estrogens, which in turn relates to the role of estrogen receptors in tumor growth Currently it is believed that the tumor has its origin in the posterolateral wall of the nasal cavity, where the sphenoid process of palatine bone meets the horizontal lamina of the vomer and part of the pterygoid process of sphenoid bone.
This junction forms the upper margin of the sphenopalatine where lies the posterior portion of the middle turbinate. From your point of origin then begins its growth beneath the mucosa, extending initially to the posterior nasal cavity and nasopharynx 4. Its blood supply is done by the internal maxillary artery, may also be branches of the ipsilateral internal carotid artery 4,6.
The classic triad of epistaxis, unilateral nasal obstruction and a mass in the nasopharynx suggests the diagnosis of NAJ and is then supplemented by imaging tests 2,4,7, Computed tomography CTmagnetic resonance imaging MRI and endoscopic examinations are the choice to define the extent and location of the tumor, allowing thus staged. Other methods such as hormone therapy, radiotherapy and chemotherapy treatment modalities are now used occasionally as complementary treatments 9,14,16,17, The surgical approach can be made through open, as the transpalatal, transmaxillary, rhinotomy lateral mid-facial degloving osteotomy and Le Fort type I 3,6,8,9,16, With the advent of minimally invasive techniques, endoscopic surgery has been used to treat NAJ in recent years 19ideal for tumors confined to the nasopharynx, nasal cavity, and sphenoid sinuses with minimal extension into the pterygopalatine fossa 2, 4,6,8,14, The first mention of an endoscopic resection date of Since then a number of cases were reported and all showed that endoscopic resection had a lower morbidity for the early stages of disease 2.
Since according to their ranking in the various staging systems are tabulated in Table 1. Technique The five patients in this series had treatment by endoscopic nasoangiofibroma being that for such surgery was performed with access through both nostrils, the technique of two surgeons and four hands technique.
We performed a columellar incision intersects similar to access to the perichondrium of the septum septoplasty nasoangiofibroma the opposite side. For after septoplasty, a window was made in the cartilaginous septum, enabling you to enter through this passage one or two tools in handling the second surgeon. This deception has brought us more space for access to tumor All surgeries were performed under general anesthesia, days after angiography with embolization of the tumor.
The following solution was used topical 1: We started the first surgical dissection of the tumor through a unciform process incision, anterior and posterior ethmoidectomy with wide exposure of the lamina papyracea and the ethmoid roof. As partial middle turbinectomy and maxillary antrostomy opening wide across posterior fontanelle. These procedures were performed early in the surgery so we could anchor in parameters and well-known landmarks.
After this sequence was performed inferior turbinectomy nearest the insertion of the inferior turbinate to the lateral nasal wall, with subsequent removal of the medial wall of maxilla. So you have access to the wide portion of the maxillary sinus, greatly facilitating the resection of tumors with lateral extension to the infratemporal fossa. We performed the opening of the posterior wall of the maxillary sinus with the aid of a Kerrison forceps delicate.
Angiofibroma juvenil nasofaríngeo
After exposure of the pterygopalatine and infratemporal fossa was performed under constant traction of the second surgeon, meticulous dissection of the tumor from the surrounding anatomical structures that until identification of the pedicle of the tumor. Who was cauterized with bipolar cautery Figure 2.
Patients numbers two and three see table due to the large size of the tumor was performed in the same section in two parts split in half. Since the division of the tumor was performed preferably the portion of smaller diameter almost always at the height of the sphenopalatine foramen near the side wall of the nasal cavity and dividing this act was carried out only after control of adjacent structures such as septum, middle turbinate and lateral nasal wall.
Following two years there were two recurrences in patients with just two and three Figures 1 and 3. However these patients had the following characteristics, the number two is the youngest patient in the study group, which for some authors is related to increased tumor aggressiveness.
Patient number three on the eve of surgery hospitalized for respiratory failure and high occupancy by the nose and oropharynx by nasoangiofibroma. He underwent a tracheotomy prior to secure the airway by nawofaringeo character. This patient is awaiting examination for staging and subsequent treatment planning. CT of the paranasal sinuses. How to cite this article. Traditionally, angiofirboma NAJ has been parched by transfacial, transoral or combined craniofacial access.
All these procedures lead to changes in the growth of the midface and craniofacial deformities even because of osteotomies performed uuvenil these procedures.
Over the years the access route for the treatment of NAJ has been modified with the aim of developing techniques with lower morbidity and lower incidence of recurrence.
Recently, the endoscopic approach has emerged as a surgical option for treating these tumors 4.
Initially used to treat diseases such as non-neoplastic polyps and sinus disease, the development of the technique enabled the excision of benign and malignant tumors located more recently 5. The endoscopic resection is best indicated for small tumors confined to the nasopharynx, nasal cavity, ethmoid and sphenoid, and in some cases, tumors with extension into the pterygopalatine fossa 4.
In a study published in a number of patients classified as stage IA and IIB Radkowski, were considered by all authors as appropriate for endoscopic resection More recently some authors have reported endoscopic resection in stages I through IIIA Radkowski be demonstrated to be safe, effective, decrease blood loss during surgery, as well as lower rates of complications, hospitalization time and rate of tumor recurrence, especially in tumors without intracranial extension 9,17,22, The main advantage of endoscopic surgery is the possibility of obtaining a broad view of the lesion and its anatomic relationship with adjacent structures, promoting more accurate, complete dissection and better control of bleeding 9,14, Other advantages include less surgical time, hospitalization, absence of visible scars, avoids complications such as epiphora, dysesthesia, trismus, and craniofacial deformities 2,5,14, The major concern regarding the choice of pathway is the rate of tumor recurrence, which has generated much discussion.
Tumor recurrence in the long run has been a frustration. However, recurrence reflects an initial incomplete resection. The recurrence rate of tumors resected endoscopically has been shown to be low. MANN et al 21 in a retrospective study found a recurrence rate of 6.
NICOLAI et al 9 in their series of 15 patients found only one patient with a residual lesion on follow-up of 24 months. Perhaps we can attribute the lower rate of recurrence of tumors resected endoscopically because these are the early stages, enabling its complete removal, as for more advanced tumors, such as stage III with greater extension to middle cranial fossa and stage IV, this kind of access is contraindicated 5,6,21, HUANG et al 25 show that the technique with two surgeons via the transseptal later shows less morbidity and lower rate of recurrence after resection of the tumor proper.
The five patients in this study underwent endoscopic resection four days after arteriography with embolization. To remove the tumor in two patients, the tumor section was performed in two halves, the largest of which was removed by transoral route. Due to the fullest extent of the tumor in two patients, the section was performed in two parts of the tumor being removed most of the transoral route and the technique of “adenoidectomy”.
We can see that this technique allows easier resection of large tumors staged as SCI. Given the short period of patient follow-up, there were only two relapses in two years. Therefore there is need for further action to claim that this technique has a low recurrence rate, since the recurrence is probably related to incomplete resection of the initial tumor.
Nasopharyngeal angiofibroma: Our experience and literature review
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Pathogenisis of Juvenile Nasopharyngeal Fibroma A new concept. The Journal of Laryngology and Otology. Aromatase may play a critical role in the pathogenesis juveil juvenile nasopharyngeal angiofibroma.
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