short description of angiofibroma

1. Juvenile
nasopharyngeal
ANGIOFIBROMA

2.  Benign tumour of nasopharynx.
 Occurs mainly in males in second decades.
 More common in south east asia,middle east
and India.
 AETIOLOGY
 Unknown . Endocrinal –occurs during puberty
sex homones testosterone release.

3. Site of origin and extensions
 Arise from base of medial pterygoid plate and
sphenopalatine foramen.
 Secondary involvement by vascular attachments
following pressure ulcerations of the lining epithelium.
 Grows into the nasal cavity , nasopharynx and behind
the posterior wall of maxillary sinus.
 Laterally into the pterygomaxillary fossa and to the
infratemporal fossa and cheek.
 Grows superiorly into the base of skull and ethmoids.
 Extends into orbit through inf. Orbital fissure giving
rise to proptosis and frog face deformity

4. pathology
 Consists of vascular spaces with no
contractile elements in the walls ,surrounded
by fibrous tissue arising from a broad base in
roof of nasopharynx.
 incidence of bleeding more common at
operation as the vessels lose the ability to
contract.(no muscle coat)

5. Clinical features
 Age- usually between 12 – 20 years.
 Sex – predominantly males.
 Profuse and recurrent epistaxis.
 Nasal speech- rinolalia clausa.
 Conductive hearing loss due to S.O.Media.
 Late cases broadening of nasal cavity – frog
face deformity, cheek swelling and proptosis.

6. Investigation
 X-ray Waters view of PNS and lat. view of skull -
space between maxilla and mandible widened in
case of cheek extension.
 Post nasal mirrors and diagnostic nasal
endoscopy useful.
 Ct-scan to see destruction of bony plates and MRI
to see vascularity within the tumour.
 Biopsy done carefully punch not done.
 Carotid angiography to identify the feeding vessels
and for pre operative embolization.
 Routine blood and urine tests.

7. staging
 Stage 1 - tumour confined to nasopharynx.
 Stage2 - extensions into the nasal cavity or
sphenoid sinus.
 Stage3 - extension into antrum, ethmoid
sinuses, pterygo maxillary or infratemporal
fossa,orbit,cheek or any combination.
 Stage4 - Intracranial extension.

8. treatment
 (choice of is surgery. Commonly transpalatal
approach (wilson’s appproach),lateral
rhinotomy+medial maxillectomy for post ethmoids
and infratemporal fossa extensions, and trans
antral appproach in cases of extra pharyngeal
extensions. Maxillary swing. Nowadays
Endoscopic transnasal approach for small masses
inside the nasal cavity.
 Hormone therapy eostrogen therapy- stilbesterol
2.5mg t.i.d for 3weeks reduce vascularity of tumour.
 Radiotherapy to decrease size and vascularity.
 Vascularity of tumours decreased by pre operative
embolization 48hrs before surgery.