ENDOSCOPIC SURGERY FOR JUVENILE ANGIOFIBROMA

1. 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.

2. 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

3. Spread:
• Sfenopalatinal foramen
• NF i nasal cavityn
• Bone errosion. sphenoid,
ethmoid and maxilar
sinus, pterygomaxillary
fosa, infratemporalna
fossa, orbit
• intracranial invasion
(middle cranial fossa)

4. • 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

5. Dg:
• NMR
• Angiography
• Endoskopy
• NO biopsy!

6. Feeding vessels:
• A. sphenopalatina
(a. maxillaris)
• 50 % - additional
feeding
• 2/3 unilateral
• 1/3 contralateral
vascularisation

7. Th:
• Surgery
• Radiotherapy
• Chemotherapy
• Embolization - ( 24-72h)
• Authologous blood transfusion

8. Surgical options:
• Transpalatal
• Transfacial
• Transhyoid
• Infratemporal
• Endonasal

9. 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

10. 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

11. Postsurgical follow up:
• NMR
first year - 4 month.
next 4 years – 6 month

12. • 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