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In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma

Published online by Cambridge University Press:  04 March 2016

A Mishra ,
S C Mishra ,
V Verma ,
H P Singh ,
S Kumar ,
A M Tripathi ,
B Patel  and
V Singh
A Mishra*
Affiliation:
Department of Otorhinolaryngology, King George Medical University, Lucknow, India
S C Mishra
Affiliation:
Department of Otorhinolaryngology, King George Medical University, Lucknow, India Visiting Professor at Nepalgunj Medical College, Nepal
V Verma
Affiliation:
Department of Otorhinolaryngology, King George Medical University, Lucknow, India
H P Singh
Affiliation:
Department of Otorhinolaryngology, King George Medical University, Lucknow, India
S Kumar
Affiliation:
Department of Otorhinolaryngology, King George Medical University, Lucknow, India
A M Tripathi
Affiliation:
Department of Otorhinolaryngology, King George Medical University, Lucknow, India
B Patel
Affiliation:
Department of Otorhinolaryngology, King George Medical University, Lucknow, India
V Singh
Affiliation:
Department of Otorhinolaryngology, King George Medical University, Lucknow, India
*
Address for correspondence: Dr Anupam Mishra, Department of Otorhinolaryngology, King George Medical University, Lucknow, India E-mail: amishra_ent@yahoo.com
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Abstract

Background:

Juvenile nasopharyngeal angiofibroma often presents with lateral extensions. In countries with limited resources, selection of a cost-effective and least morbid surgical approach for complete excision is challenging.

Methods:

Sixty-three patients with juvenile nasopharyngeal angiofibroma, with lateral extensions, underwent transpalatal, transpalatal-circumaxillary (transpterygopalatine) or transpalatal-circumaxillary-sublabial approaches for resection. Clinico-radiological characteristics, tumour volume and intra-operative bleeding were recorded.

Results:

The transpalatal approach was suitable for extensions involving medial part of pterygopalatine fossa; transpalatal-circumaxillary for extensions involving complete pterygopalatine fossa, with or without partial infratemporal fossa; and transpalatal-circumaxillary-sublabial for extensions involving complete infratemporal fossa, even cheek or temporal fossa up to zygomatic arch. Haemorrhage was greatest with the transpalatal-circumaxillary-sublabial approach, followed by transpalatal approach and transpalatal-circumaxillary approach (1212, 950 and 777 ml respectively). Tumour size (volume) was greatest with the transpalatal-circumaxillary approach, followed by transpalatal-circumaxillary-sublabial approach and transpalatal approach (40, 34 and 29 mm3). There was recurrence in three cases and residual disease in two cases. Long-term morbidity included small palatal perforation (n = 1), trismus (n = 1) and atrophic rhinitis (n = 2).

Conclusion:

These modified techniques, performed with endoscopic assistance under hypotensive anaesthesia, without embolisation, offer a superior option over other open procedures with regard to morbidity and recurrences.

Keywords

Nasopharyngeal NeoplasmsAngiofibroma
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 5 , May 2016 , pp. 462 - 473
Copyright
Copyright © JLO (1984) Limited 2016 

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