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1. JUVENILE NASOPHARYNGEAL
ANGIOFIBROMA
R A A F I U L B A S H E E R Z A R G A R

2. INTRODUCTION
 It is also known as
nasopharyngeal
fibroma .
 It is a rare tumor
but commonest of
all benign tumor of
nasopharynx.

3. ETIOLOGY
 Idiopathic
 Mostly seen in adolescent males in 2nd decade of
life.
 Hormonal Theory
• Testosterone dependent
• Patients have a hamartomatous nidus of vascular
tissue and this is activated to form angiofibroma
when male sex hormone appears.

4. SITE
Posterior part of
nasal cavity close
to the superior
margin of
sphenopalatine
foramen

5. GROWTH
 Locally invasive benign
tumors.
 From site of origin to nasal
cavity, nasopharynx and
into the pterygopalatine
fossa, running behind the
posterior wall of maxillary
sinus which is pushed
forward as the tumor
grows. Laterally it extends
into pterygomaxillary
fossa then to
infratemporal fossa and
cheek.

6. PATHOLOGY
Severe bleeding as the vessels lose ability to contract
Made up of vascular and fibrous tissue mostly the vessels are just
endothelium lined spaces with no elastic or muscle coat

7. MICROSCOPIC
APPERANCE
ENDOTHELIUM
STROMA

8. EXTENSION
 Nasal cavity- Causing nasal obstruction,
epistaxis and nasal discharge
 Paranasal sinuses- Maxillary, sphenoid and
ethmoid sinuses can all be invaded
 Pterygomaxillary fossa, infratemporal fossa
and cheek
 Orbits-proptosis, frog face deformity

9. EXTENSION
 CRANIAL CAVITY
• ANTERIOR CRANIAL FOSSA
through roof of ethmoids or
cribriform plate
• MIDDLE CRANIAL FOSSA
through erosion of floor of middle
cranial fossa or indirectly by
invading the sphenoid sinus and
sella tunica.

10. SYMPTOMS
SEX-MOSTLY IN
MALES AGE-10-20YRS
PROFUSE, RECURRENT AND
PAINLESS EPISTAXIS LEAD TO
ANAEMIC DUE TO REPEATED
BLOOD LOSS.

11. SYMPTOMS
 Progressive nasal obstruction and denasal
speech
 Conductive hearing loss and otitis media with
effusion
 Mass in the nasopharynx
 Broadening of nasal bridge
 Proptosis
 Swelling of cheek
 Conductive hearing loss and serous otitis
media due to obstruction of Eustachian tube

12. SIGNS
 Anterior Rhinoscopy –
1. Pink or purplish nasopharyngeal mass
2. sessile, lobulated or smooth
3. obstructs one or both choanae
4. Consistency is firm but digital palpation is
never done because it can result in
profuse bleeding.

13. INVESTIGATIONS
 CT Scan
• Investigation of choice
• The extent of tumour,
bony destruction or
displacements can be
seen.
• Hollman-Miller Sign
Anterior bowing of maxilla
and Posterior bowing of
ptyerigoid.
Contrast CT scan juvenile
nasopharyngeal angiofibroma.
Note the pterygopalatine fossa
and infratemporal fossa
extension

14. INVESTIGATIONS
 MRI
 Carotid angiography
shows the extent of
tumors

15. STAGING
 Sessions’s classification, modified by Radkowski reflects
 IA Tumor limited to nose and nasopharyngeal vault
 IB Extension to paranasal sinuses
 IIA Minimal extension to pterygomaxillary fissure (PMF)
 IIB Full extension to PMF and/or erosion of orbital bones
 IIC Extension to infratemporal fossa and/or cheek or
posterior to pterygoid plates
 IIIA Erosion of skull base: minimal intracranial
 IIIB Extensive intracranial and/or cavernous sinus
extension

16. MEASURES TO REDUCE THE
VASCULARITY OF THE
TUMORREDUCE THE
VASCULARITY OF TUMOR
LARITY OF TUMOR
• .
• Embolization of the feeding vessels.
• Estrogen therapy: Stilboestrol 2.5 mg three
times a day for 3 weeks. Not preferred
currently.
• Preoperative radiation: Generally not
favored.
• Cryotherapy.

17. TREATMENT(OPEN
SURGICAL EXCISION)
 Surgical approaches
 Transpalatine: Tumours confined to nasopharynx, nasal cavity and
sphenoid sinus.
 Le Fort 1 osteotomy approach: For extension to paranasal sinuses,
pterygopalatine fossa and infratemporal fossa.
 Medial maxillectomy: It provides access to orbit, ethmoid and sphenoid
sinuses and anterior skull base.
 Sardana’s approach: Transpalatine + Sublabial.
 Extended lateral rhinotomy
 Extended Denker’s approach
 Intracranial-extracranial
 Infratemporal fossa

18. TREATMENT

19. TREATMENT
 RADIATION
THERAPY
• For advanced tumors
with intracranial
extension

20. COMPLICATIONS
 Secondary
malignancy
 Abnormal
craniofacial
development
 Cataracts
 Optic atrophy
 Osteoradionecrosis.

21. MANAGEMENT OF
RECURRENCE
 Radiotherapy
• 3000-3500 cGy of radiation given in 15 to
20 sittings.
 Chemotherapy
• Drugs like Vincristine, Doxorubicin ,
Dacarbazine
 The above methods can arrest the growth
and cause tumor regression but not total
tumor eradication

22. PROGNOSIS
Excellent prognosis on
complete surgical
removal.

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