8-nasopharyngeal-angiofibroma1.doc

8/10/2019 8-nasopharyngeal-angiofibroma1.doc

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asopharyngealAngiofibroma

Dr. Vishal Sharma

A i fib


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Definition

Benign tumor of nasopharynx (?), locally

nvasive, extremely vascular occurs in

!olescent males.

amartomatous ni!us of vascular tissue,

epen!ent on testosterone.

ynonyms" nasopharyngeal fibroma,

angiofibroma


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Site of originArises in posterior nasal cavity, near superior

bor!er sphenopalatine


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Sphenopalatine foramen


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#athology

ross" Sessile, bi$lobe!, rubbery, re!$pin% or

ray colour.

istology" &ncapsulate!, compose! of vascular

ssue fibrous stroma. Vessels are thin$'alle!,

c% elastic fibers smooth muscle (this lea!s

uncontrolle! blee!ing).


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istopathology


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Small tumour


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asal cavity


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asal cavity #..S.


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asopharynx


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#terygopalatine fossa


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*nfratemporal fossa


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*nfratemporal fossa


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+hee%


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rbit


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Sphenoi! sinus


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-i!!le cranial fossa


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#ituitary +avernous sinus


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Sprea!

nterior" asal cavity paranasal sinus

sterior" asopharynx

ateral" goes to #terygopalatine fossa

/. *nfratemporal fossa chee%

0. *nferior orbital fissure

orbit


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Sprea!

uperior" /. Sphenoi! sinus


+avernous sinus

ptic chiasma

#ituitary fossa

0. S%ull base



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Symptoms

asal obstruction (12$324) 'ith !enasal

peech (rhinolalia clausa)

pistaxis (52$624)" #ersistent, #ainless,

#rofuse, #aroxysmal, 7nprovo%e!

ea!ache (054)

acial s'elling (024)" chee% palatal s'elling


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8acial s'elling


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Signsasal or asopharyngeal mass (124)

rog$face !eformity"

i!ge broa!ening

titis me!ia 'ith effusion"

to bloc%age

rismus" involvement of pterygoi! muscle

volvement of **, ***, *V, V* cranial nerve


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.9. scan #..S. 'ith contrast

xtent of tumor

nterior bo'ing of

osterior maxillary

all (-iller olman:s

ntral sign)

umor enhancement

one !estruction


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ther *nvestigations

.;.*." for intra$cranial involvement

igital Subtraction Angiography (D.S.A.)"

. extent of tumor

. tumour blush (!ue to increase! vascularity)

. fee!ing arteries for emboli


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agnetic ;esonance *maging


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D.S.A. before emboli


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D.S.A. after emboli


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Differential !iagnosis

;hab!omyosarcoma

Antrochoanal polyp

9eratoma

Dermoi!

&ncephalocoele

*nverting papilloma

S=uamous cell carcinoma


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Stagingtage *" 9umor limite! to nasal cavity or

nasopharynx 'ith no bony !estructiontage **" 9umor inva!ing pterygopalatine

fossa or paranasal sinuses

tage ***" 9umor inva!ing infratemporal

fossa or orbit or parasellar region

tage *V" 9umor inva!ing cavernous sinus

or optic chiasma or pituitary fossa


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#re$op re!uction oftumorvascularity

&mboli


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9rans$palatal approach


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Sar!ana:s approach


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&n!oscopic approach


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@ateral rhinotomy approach


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@ateral rhinotomy approach


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-i!facial !egloving


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Den%er:s incision

l!'ell @uc incision exten!e! me!ially till mi!line


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@e 8ort / osteotomy


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nfratemporal fossa approach


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nterior subcranial approach


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Surgical approaches

9rans$palatal approach (ilson)

small tumour in nasopharynx

Sublabial 9rans$palatal approach (Sar!ana)

large tumour of nose #S nasopharynx

*ntranasal en!oscopic approach

small tumour in nose #S nasopharynx


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Surgical approaches

9ransmaxillary approach via"

&xten!e! lateral rhinotomy incision

-i!facial !egloving incision

Den%er:s exten!e! +al!'ell$@uc incision

@e 8ort / osteotomy approach

Done for extension into pterygopalatine fossa


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Surgical approaches

*nfratemporal fossa approach (8isch)

extension into infratemporal fossa

Anterior subcranial approach

intracranial orbital extension

*mage$gui!e!, en!oscopic, laser$assiste!

removal (latest)" small me!ium si


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Surgical specimen


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Surgical specimen


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oton Stereotactic ;a!iation9herapy (#.S.;.9.)

onym" >amma %nife surgery

! for" . *ntracranial

0. ;ecurrence after surgery

ingle relatively high !ose of ra!iation !elivere!

recisely to a small area to %ill tumor cells

inimal inCury to a!Cacent nerves brain tissue


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Stereotactic ;a!iotherapy


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9han% ou

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