Jul 21, 2023
Juvenile nasopharyngeal angiofibroma is exclusively seen in the juvenile age group. Angiofibroma is a tumor filled with lots of blood vessels and fibrous tissue. It is a benign and a rare tumor but also the most common tumor of the Nasopharynx. It is exclusively seen in males because it depends upon testosterone.
The most common site of origin is from the sphenopalatine foramen (near the posterior wall of the maxillary sinus). Sphenopalatine foramen is located 8-10 mm behind the posterior end of the middle turbinate. Another site of origin are:
|IA||Limited to nose and nasopharyngeal area|
|IB||Extension into 1 or more sinuses|
|IIA||Minimal extension into pterygopalatine fossa|
|IIB||Occupation of the pterygopalatine fossa with or without orbital erosion|
|IIC||Infratemporal fossa extension with or without cheek or pterygoid plate involvement|
|IIIA||Erosion of the skull base (middle cranial fossa or pterygoids)|
|IIIB||Erosion of skull base with intracranial extension with or without cavernous sinusinvolvement|
Below are mentioned some of the clinical features of juvenile nasopharyngeal angiofibroma
Diagnosis can be made with the help of following methods:
CT diagnosis is based on two constant features
When the wedge of the pterygoid is eroded so the medial and lateral pterygoid plate look like a separate plate, that is called the Chopstick sign.
Angiography provides information on the specific blood supply of the tumor. The most common blood vessel supplying the tumor is internal maxillary artery. It is also used as treatment with embolization.
The internal maxillary artery is the most common vascular source from which juvenile nasopharyngeal angiofibroma arises. Other known vessels include ascending pharyngeal artery
No biopsy is done for juvenile nasopharyngeal angiofibroma. Only when radiotherapy is contemplated due to the inoperability of the tumor is one exception when the biopsy is done.
Treatment of choice for juvenile nasopharyngeal angiofibroma is surgery with preoperative embolization. To decrease vascularity
Radiotherapy is used when there is
Recurrence rate of 20-30% can expected with radiation therapy alone. Newer techniques in radiotherapy treatment such as intense modulated conformal radiotherapy (IMRT) and gamma knife have shown good results.
Diethylstilbestrol with flutamide is used because it is testosterone dependence. Chemotherapy for residual/recurrent disease includes doxorubicin, vincristine, and dacarbazine.
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