endoscopic surgery for juvenile angiofibroma

ENDOSCOPIC SURGERY FOR

JUVENILE ANGIOFIBROMA

two cases

Department of Otorhinolaryngology

and Head & Neck Surgery, Sestre milosrdnice

hospital, Zagreb

Baudoin T, Shejbal D, Grgić M, Drviš P, Stevanović S.

Juvenile angiofibroma:

• Highly vascularized benign tumor

• Vascular malformation

• Loc. invasive

• Children and adolescent boys

• Nasal obstruction and epistaxis

• Purpur polypoid NF mass

• Origin: NF or lateral wall of nasal cavity

Spread:

• Sfenopalatinal foramen

• NF i nasal cavityn

• Bone errosion. sphenoid,

ethmoid and maxilar

sinus, pterygomaxillary

fosa, infratemporalna

fossa, orbit

• intracranial invasion

(middle cranial fossa)

• I - tm limited to the NF

• II – invading the pterygopalatine fossa, sphenoid, ethmoid and maxilary sinus with bone destruction,

• III – invading infratemporalne fosse or orbital region or extradural intracranial invasion

• IV – intracranial intradural tumor

Dg:

• NMR

• Angiography

• Endoskopy

• NO biopsy!

Feeding vessels:

• A. sphenopalatina

(a. maxillaris)

• 50 % - additional

feeding

• 2/3 unilateral

• 1/3 contralateral

vascularisation

Th:

• Surgery

• Radiotherapy

• Chemotherapy

• Embolization - ( 24-72h)

• Authologous blood transfusion

Surgical options:

• Transpalatal

• Transfacial

• Transhyoid

• Infratemporal

• Endonasal

Endoscopic treatment:

• ETA, hypotension

• Uncinectomy, part. or total resection of the middle turbinate

• Ant. and post. ethmoidectomy

• Wide middle antrostomy

• Ressecion post. septum wall with mass

• Mass removed transoraly or transnasal

• Bipollar cautery, laser

• 3D - navigation

Endoscopic treatment (II):

• advantages:

magnified, multy angled view

it does not require any skin or mucosal incision or osteotomy

• limitations:

availability of only one hand for surgical maneuvers

usefull only for I and II type

Postsurgical follow up:

• NMR

first year - 4 month.

next 4 years – 6 month

• 12 and 14 year old boy wit angiofibroma of right nasal cavity

• 4 months ago: nasal obstruction with occasional epistaxis

• Diagnosis: X ray and anterior rhynoscopy

• younger boy:

sideropenic anemias