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Transpalatal approach in juvenile nasopharyngeal angiofibroma

Year 2007, Volume: 17 Issue: 1, 7 - 12, 12.01.2007

Abstract

Objectives: Juvenile nasopharyngeal angiofibroma JNA cases treated with transpalatal approach were evaluated with respect to localization, complications, intraoperative blood loss, recurrence, and prognosis. Patients and Methods: The study included 15 male patients mean age 13 years; range 10 to 16 years treated for JNA. The patients were classified according to the Chandler staging system. Transpalatal surgical excision was performed in 14 patients. Preoperative embolization of the maxillary arteries was performed in three patients. One patient with intracranial extension was treated with radiotherapy. The mean follow-up was 3 years-7 months range 7 months to 7 years . Results: Three patients 20% had Chandler stage II, 11 patients 73% had stage III, and one patient 7% had stage IV disease. The mean intraoperative blood loss was 575 ml in three patients with preoperative embolization, and 1,079 ml in those without embolization. The average intraoperative transfusion requirement was 2.3 units. Recurrences developed in three patients 20% , two of whom were treated by surgery and one by radiotherapy. Conclusion: Transpalatal surgical approach is effective in the treatment of JNAs localized in the nasopharynx, nasal cavity, and sphenoid sinuses, with minimal mortality and morbidity.

References

  • Iannetti G, Belli E, De Ponte F, Cicconetti A, Delfini R. The surgical approaches to nasopharyngeal angiofi- broma. J Craniomaxillofac Surg 1994;22:311-6.
  • Danesi G, Panizza B, Mazzoni A, Calabrese V. Anterior approaches in juvenile nasopharyngeal angiofibromas with intracranial extension. Otolaryngol Head Neck Surg 2000;122:277-83.
  • Kamel RH. Transnasal endoscopic surgery in juvenile nasopharyngeal angiofibroma. J Laryngol Otol 1996; 110:962-8.
  • Scholtz AW, Appenroth E, Kammen-Jolly K, Scholtz LU, Thumfart WF. Juvenile nasopharyngeal angiofi- broma: management and therapy. Laryngoscope 2001; 111(4 Pt 1):681-7.
  • Browne JD, Jacob SL. Temporal approach for resection of juvenile nasopharyngeal angiofibromas. Laryngoscope 2000;110:1287-93.
  • Deschler DG, Kaplan MJ, Boles R. Treatment of large juvenile nasopharyngeal angiofibroma. Otolaryngol Head Neck Surg 1992;106:278-84.
  • Ochoa-Carrillo FJ, Carrillo JF, Frias M. Staging and treatment of nasopharyngeal angiofibroma. Eur Arch Otorhinolaryngol 1997;254:200-4.
  • Zhang M, Garvis W, Linder T, Fisch U. Update on the infratemporal fossa approaches to nasopharyngeal angiofibroma. Laryngoscope 1998;108(11 Pt 1):1717-23.
  • Nakamura H, Kawasaki M, Higuchi Y, Seki S, Takahashi S. Transnasal endoscopic resection of juve- nile nasopharyngeal angiofibroma with KTP laser. Eur Arch Otorhinolaryngol 1999;256:212-4.
  • Göçmen H, Samim E, Eryılmaz A, Özeri C. Nazofaren- geal anjiofibroma sınıflandırma, cerrahi tedavi ve re- kürrens. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi 1995;3:236-46.
  • Köybaşıoğlu A, İleri F, Kemaloğlu Y, Göksu N, İnal E, Şener T ve ark. Pterigopalatin fossa uzanımlı anjiofib- romların cerrahi tedavisinde midfasiyal-degloving yöntemi. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi 1996;4:66-9.
  • Tosun F, Gerek M, Yetişer S, Özkaptan Y. Benign nazal tümörlere endonazal endoskopik yaklaşım. Kulak Bu- run Boğaz Klinikleri 2000;2:41-5.
  • Chandler JR, Goulding R, Moskowitz L, Quencer RM. Nasopharyngeal angiofibromas: staging and manage- ment. Ann Otol Rhinol Laryngol 1984;93:322-9.
  • Radkowski D, McGill T, Healy GB, Ohlms L, Jones DT. Angiofibroma. Changes in staging and treatment. Arch Otolaryngol Head Neck Surg 1996;122:122-9.
  • Dillard DG, Cohen C, Muller S, Del Gaudio J, Reichman O, Parrish B, et al. Immunolocalization of activated transforming growth factor beta1 in juvenile nasopharyngeal angiofibroma. Arch Otolaryngol Head Neck Surg 2000;126:723-5.
  • Roberts JK, Korones GK, Levine HL, Wood BG, Tucker HM, Lavertu P. Results of surgical management of nasopharyngeal angiofibroma. The Cleveland Clinic experience, 1977-1986. Cleve Clin J Med 1989;56:529-33.
  • Moulin G, Chagnaud C, Gras R, Gueguen E, Dessi P, Gaubert JY, et al. Juvenile nasopharyngeal angiofibro- ma: comparison of blood loss during removal in embolized group versus nonembolized group. Cardiovasc Intervent Radiol 1995;18:158-61.
  • Tranbahuy P, Borsik M, Herman P, Wassef M, Casasco A. Direct intratumoral embolization of juvenile angiofibroma. Am J Otolaryngol 1994;15:429-35.
  • Koç C. Özdem C, Arıkan OK, Beriat K. Jüvenil nazofa- rengeal anjiofibrom tedavisinde pre-operatif polivinil alkol embolizasyonunun klinik değeri. Türk Otolaren- goloji Arşivi 2001;39:267-72.
  • Li JR, Qian J, Shan XZ, Wang L. Evaluation of the effec- tiveness of preoperative embolization in surgery for nasopharyngeal angiofibroma. Eur Arch Otorhino- laryngol 1998;255:430-2.
  • Stansbie JM, Phelps PD. Involution of residual juvenile nasopharyngeal angiofibroma (a case report). J Laryngol Otol 1986;100:599-603.
  • Waldman SR, Levine HL, Astor F, Wood BG, Weinstein M, Tucker HM. Surgical experience with nasopharyn- geal angiofibroma. Arch Otolaryngol 1981;107:677-82.
  • Gullane PJ, Davidson J, O’Dwyer T, Forte V. Juvenile angiofibroma: a review of the literature and a case series report. Laryngoscope 1992;102:928-33.
  • Harma RA. Nasopharyngeal angiofibroma. Acta Otolaryngol 1958;49(Suppl 146):7-74.
  • Howard DJ, Lloyd G, Lund V. Recurrence and its avoidance in juvenile angiofibroma. Laryngoscope 2001;111:1509-11.
  • Lloyd G, Howard D, Phelps P, Cheesman A. Juvenile angiofibroma: the lessons of 20 years of modern imag- ing. J Laryngol Otol 1999;113:127-34.

Juvenil nazofarenks anjiyofibromunda transpalatal yaklaşım

Year 2007, Volume: 17 Issue: 1, 7 - 12, 12.01.2007

Abstract

Amaç: Juvenil nazofarenks anjiyofibromu nedeniyletranspalatal yaklaşım uygulanan olgular tümör yerleşimi, tedavi, komplikasyonlar, ameliyat sırasında kanama, nüks ve prognoz açısından gözden geçirildi.Hastalar ve Yöntemler: Çalışmaya juvenil nazofarenks anjiyofibromu tanısıyla tedavi edilen 15 erkekhasta alındı. HastalarChandler sınıflamasına göre evrelendirildi. Tedavide14 hastaya transpalatal eksizyon yapıldı. Üç hastaya ameliyattan önce maksiller arter embolizasyonuuygulandı. İntrakraniyal uzanım saptanan bir hastaya primer radyoterapi uygulandı. Ortalama takip süresi 3 yıl-7 ay dağılım 7 ay-7 yıl idi. Bulgular: Chandler sınıflamasına göre, üç hastada %20 evre II, 11 hastada %73 evre III, bir hastada %7 evre IV tümör saptandı. Ameliyat sırasında,embolizasyon yapılan üç hastada ortalama 575 mlkanama olurken, embolizasyon yapılmayan 12 hastada ortalama kanama miktarı 1079 ml idi. Ortalama2.3 ünite kan transfüzyonu yapıldı. Üç hastada %20 nüks oluştu, bunların ikisi cerrahi tedavi uygulanan, biri ise radyoterapi uygulanan hastalardı.Sonuçlar: Nazofarenks, nazal kavite ve sfenoid sinüsyerleşimli juvenil nazofarenks anjiyofibromunun tedavisinde transpalatal cerrahi yaklaşımın etkili olduğu,mortalite ve morbiditesinin az olduğu söylenebilir

References

  • Iannetti G, Belli E, De Ponte F, Cicconetti A, Delfini R. The surgical approaches to nasopharyngeal angiofi- broma. J Craniomaxillofac Surg 1994;22:311-6.
  • Danesi G, Panizza B, Mazzoni A, Calabrese V. Anterior approaches in juvenile nasopharyngeal angiofibromas with intracranial extension. Otolaryngol Head Neck Surg 2000;122:277-83.
  • Kamel RH. Transnasal endoscopic surgery in juvenile nasopharyngeal angiofibroma. J Laryngol Otol 1996; 110:962-8.
  • Scholtz AW, Appenroth E, Kammen-Jolly K, Scholtz LU, Thumfart WF. Juvenile nasopharyngeal angiofi- broma: management and therapy. Laryngoscope 2001; 111(4 Pt 1):681-7.
  • Browne JD, Jacob SL. Temporal approach for resection of juvenile nasopharyngeal angiofibromas. Laryngoscope 2000;110:1287-93.
  • Deschler DG, Kaplan MJ, Boles R. Treatment of large juvenile nasopharyngeal angiofibroma. Otolaryngol Head Neck Surg 1992;106:278-84.
  • Ochoa-Carrillo FJ, Carrillo JF, Frias M. Staging and treatment of nasopharyngeal angiofibroma. Eur Arch Otorhinolaryngol 1997;254:200-4.
  • Zhang M, Garvis W, Linder T, Fisch U. Update on the infratemporal fossa approaches to nasopharyngeal angiofibroma. Laryngoscope 1998;108(11 Pt 1):1717-23.
  • Nakamura H, Kawasaki M, Higuchi Y, Seki S, Takahashi S. Transnasal endoscopic resection of juve- nile nasopharyngeal angiofibroma with KTP laser. Eur Arch Otorhinolaryngol 1999;256:212-4.
  • Göçmen H, Samim E, Eryılmaz A, Özeri C. Nazofaren- geal anjiofibroma sınıflandırma, cerrahi tedavi ve re- kürrens. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi 1995;3:236-46.
  • Köybaşıoğlu A, İleri F, Kemaloğlu Y, Göksu N, İnal E, Şener T ve ark. Pterigopalatin fossa uzanımlı anjiofib- romların cerrahi tedavisinde midfasiyal-degloving yöntemi. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi 1996;4:66-9.
  • Tosun F, Gerek M, Yetişer S, Özkaptan Y. Benign nazal tümörlere endonazal endoskopik yaklaşım. Kulak Bu- run Boğaz Klinikleri 2000;2:41-5.
  • Chandler JR, Goulding R, Moskowitz L, Quencer RM. Nasopharyngeal angiofibromas: staging and manage- ment. Ann Otol Rhinol Laryngol 1984;93:322-9.
  • Radkowski D, McGill T, Healy GB, Ohlms L, Jones DT. Angiofibroma. Changes in staging and treatment. Arch Otolaryngol Head Neck Surg 1996;122:122-9.
  • Dillard DG, Cohen C, Muller S, Del Gaudio J, Reichman O, Parrish B, et al. Immunolocalization of activated transforming growth factor beta1 in juvenile nasopharyngeal angiofibroma. Arch Otolaryngol Head Neck Surg 2000;126:723-5.
  • Roberts JK, Korones GK, Levine HL, Wood BG, Tucker HM, Lavertu P. Results of surgical management of nasopharyngeal angiofibroma. The Cleveland Clinic experience, 1977-1986. Cleve Clin J Med 1989;56:529-33.
  • Moulin G, Chagnaud C, Gras R, Gueguen E, Dessi P, Gaubert JY, et al. Juvenile nasopharyngeal angiofibro- ma: comparison of blood loss during removal in embolized group versus nonembolized group. Cardiovasc Intervent Radiol 1995;18:158-61.
  • Tranbahuy P, Borsik M, Herman P, Wassef M, Casasco A. Direct intratumoral embolization of juvenile angiofibroma. Am J Otolaryngol 1994;15:429-35.
  • Koç C. Özdem C, Arıkan OK, Beriat K. Jüvenil nazofa- rengeal anjiofibrom tedavisinde pre-operatif polivinil alkol embolizasyonunun klinik değeri. Türk Otolaren- goloji Arşivi 2001;39:267-72.
  • Li JR, Qian J, Shan XZ, Wang L. Evaluation of the effec- tiveness of preoperative embolization in surgery for nasopharyngeal angiofibroma. Eur Arch Otorhino- laryngol 1998;255:430-2.
  • Stansbie JM, Phelps PD. Involution of residual juvenile nasopharyngeal angiofibroma (a case report). J Laryngol Otol 1986;100:599-603.
  • Waldman SR, Levine HL, Astor F, Wood BG, Weinstein M, Tucker HM. Surgical experience with nasopharyn- geal angiofibroma. Arch Otolaryngol 1981;107:677-82.
  • Gullane PJ, Davidson J, O’Dwyer T, Forte V. Juvenile angiofibroma: a review of the literature and a case series report. Laryngoscope 1992;102:928-33.
  • Harma RA. Nasopharyngeal angiofibroma. Acta Otolaryngol 1958;49(Suppl 146):7-74.
  • Howard DJ, Lloyd G, Lund V. Recurrence and its avoidance in juvenile angiofibroma. Laryngoscope 2001;111:1509-11.
  • Lloyd G, Howard D, Phelps P, Cheesman A. Juvenile angiofibroma: the lessons of 20 years of modern imag- ing. J Laryngol Otol 1999;113:127-34.
There are 26 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Evrim Ünsal Tuna This is me

Cihan Karaca This is me

Mustafa Kaymakçı This is me

Cem Özbek This is me

Cafer Özdem This is me

Publication Date January 12, 2007
Published in Issue Year 2007 Volume: 17 Issue: 1

Cite

APA Ünsal Tuna, E., Karaca, C., Kaymakçı, M., Özbek, C., et al. (2007). Juvenil nazofarenks anjiyofibromunda transpalatal yaklaşım. The Turkish Journal of Ear Nose and Throat, 17(1), 7-12.
AMA Ünsal Tuna E, Karaca C, Kaymakçı M, Özbek C, Özdem C. Juvenil nazofarenks anjiyofibromunda transpalatal yaklaşım. Tr-ENT. January 2007;17(1):7-12.
Chicago Ünsal Tuna, Evrim, Cihan Karaca, Mustafa Kaymakçı, Cem Özbek, and Cafer Özdem. “Juvenil Nazofarenks Anjiyofibromunda Transpalatal yaklaşım”. The Turkish Journal of Ear Nose and Throat 17, no. 1 (January 2007): 7-12.
EndNote Ünsal Tuna E, Karaca C, Kaymakçı M, Özbek C, Özdem C (January 1, 2007) Juvenil nazofarenks anjiyofibromunda transpalatal yaklaşım. The Turkish Journal of Ear Nose and Throat 17 1 7–12.
IEEE E. Ünsal Tuna, C. Karaca, M. Kaymakçı, C. Özbek, and C. Özdem, “Juvenil nazofarenks anjiyofibromunda transpalatal yaklaşım”, Tr-ENT, vol. 17, no. 1, pp. 7–12, 2007.
ISNAD Ünsal Tuna, Evrim et al. “Juvenil Nazofarenks Anjiyofibromunda Transpalatal yaklaşım”. The Turkish Journal of Ear Nose and Throat 17/1 (January 2007), 7-12.
JAMA Ünsal Tuna E, Karaca C, Kaymakçı M, Özbek C, Özdem C. Juvenil nazofarenks anjiyofibromunda transpalatal yaklaşım. Tr-ENT. 2007;17:7–12.
MLA Ünsal Tuna, Evrim et al. “Juvenil Nazofarenks Anjiyofibromunda Transpalatal yaklaşım”. The Turkish Journal of Ear Nose and Throat, vol. 17, no. 1, 2007, pp. 7-12.
Vancouver Ünsal Tuna E, Karaca C, Kaymakçı M, Özbek C, Özdem C. Juvenil nazofarenks anjiyofibromunda transpalatal yaklaşım. Tr-ENT. 2007;17(1):7-12.