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.
Jul 12, 2015
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