nasopahrngeal angiofibroma

1. NASOPHAYRNGEAL
ANGIOFIBROMA
PRESENTED BY Dr komal
Post-graduate resident (ENT)

2. • It is the benign and the vascular tumor
of nasopharynx. (it involves both
vascular and fibrous tissue)
• accounts for less than 0.5% of all head
and neck tumors.
• Exclusively it involves adolescent males

3. Site of origin:
• Earlier it was thought to arise from the roof of
nasopharynx or the anterior wall of the
sphenoid bone but now it is believed to arise
post part of the nasal cavity close to the
superior margin of sphenopalatine foramen.

4. Nasopharynx:

5. Age:
Onset most commonly is in the second
decade; range is 7-21 years.
Rare in patients older than 25 years.

6. Pathology and aetiology:
• The exact cause is not known but as the
tumor is pre-dominantly seen in adolescent
males in the 2nd decade of life so it is thought
to be testosterone dependant.
• Though there are number of theories
proposed but none is entirely convincing
Hormonal theory has been suggested due to
the lesion's occurrence in adolescent males.

7. Clinical features:
• Profuse and recurrent epistaxis
• Nasal obstruction results in nasal voice called as
rhinolalia clausa.
• Conductive hearing loss and serous otitis media
due to obstruction of Eustachian tube
• Mass in the nasopharynx
• Other clinical features include broadening of
nasal bridge, proptosis, swelling of cheek,
infratemporal fossa or involvement of 2,3,4,6 C.N
depends on the extent of tumor.

8. • If the swelling enlarges to force the soft
palate down, the voice may become
plummy.
• Diplopia may occur secondary to the
erosion of the mass into the cranial
cavity and causes pressure to the optic
chiasma.

9. Gross examination:
• Usually sessile, lobulated, firm in consistency,
and red-pink to tan-gray in appearance.In rare
cases, the tumor is polypoid or pedunculated
Usually is encapsulated and composed of
vascular tissue and fibrous stroma with coarse
or fine collagen fibers.
• Digital palpation is avoided as tumor can
bleed

11. Extent of tumor:
• Though it is a benign tumor but it is locally invasive it
may extend into the:
• Nasal cavity
• Paranasal sinuses
• Orbits giving rise to proptosis and frog face deformity
• Pterygomaxillary fossa, infratemporal fossa and
cheek.
• Middle cranial fossa (most common)

13. Staging of tumor:

14. Investigation:
• History
• Clinical examination
• Radiological imaging :
• Xray of paranasal sinuses and base of the skull that
shows the holman miller sign or antral sign (ant
bowing of the post wall of the maxillary sinus)
• CT scan with contrast of head is now the investigation
of choice it shows the extent of tumor, bony
destruction or displacement.
• MRI to know the soft tissue extension.

15. • Carotid angiography: shows the extension of
tumor, its vascularity and the feeding vessel so that
the embolization can be done to control the bleeding
during the surgery.

17. Treatment:
• Transpalatine
• Transpalatine+sublabial approach
• Extended lateral rhinotomy
• Via facial incion and degloving approach
• Extended denkers approach
• Endoscopic

18. • Radiotherapy: can be used in case of extension
of tumor
• Hormonal therapy: since the tumor occurs in
young males at puberty so hormonal therapy can be
used as an adjunctive treatment.
• Chemotherapy: recurrent and residual lesions
have been treated.