Juvenile nasopharyngeal angiofibroma
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Juvenile papillomatosis
Juvenile papillomatosis is the most common benign laryngeal tumor in children, caused by HPV types 6 and 11. It is thought children contract it from their mothers during birth if the mother had HPV. Papillomas typically affect the supraglottic and glottic regions but can spread lower. Children who had tracheostomies are more likely to have tracheal and stoma involvement due to seeding. Symptoms include hoarseness, difficulty breathing, or stridor in children ages 3-5. Diagnosis is via laryngoscopy and biopsy. Treatment involves laser excision to remove papillomas while preserving the voice, but recurrence is common and requires repeated procedures.
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
This document discusses juvenile nasopharyngeal angiofibroma (JNA), a rare benign but invasive tumor that arises in adolescent males near the sphenopalatine foramen. JNA presents with nasal obstruction and epistaxis. Diagnosis involves imaging like CT and MRI to determine the extent of involvement. Treatment depends on staging and may include preoperative embolization, surgery such as endoscopic resection, or radiation for advanced cases. Complete resection aims to prevent recurrence while minimizing complications like bleeding, infection, and nerve damage.
JNA
The document discusses juvenile nasopharyngeal angiofibroma (JNA), a benign but locally invasive vascular tumor that primarily affects adolescent males. It arises near the sphenopalatine foramen and can spread medially into the nasopharynx and laterally into surrounding structures. Presentation varies from nasal obstruction to cranial nerve palsies. Imaging shows a hypervascular mass often with bone erosion. Diagnosis is confirmed histologically. Staging guides surgical approach, with endoscopic resection increasingly used for early-stage tumors. Complete resection while preserving function is the goal.
Tympanosclerosis
Tympanosclerosis is characterized by hyaline deposits in the tympanic membrane and middle ear space caused by chronic infection or inflammation. It results in the degeneration of connective tissue and deposition of calcium and phosphate. Common symptoms include conductive hearing loss and occasional tinnitus. Diagnosis is made by otoscopy showing white plaques and audiometry showing a conductive hearing loss. Treatment depends on the size and location of plaques, with small plaques sometimes removed before grafting but large plaques usually just addressed with hearing aids.
Juvenile nasopharyngeal angiofibroma
Juvenile nasopharyngeal angiofibroma is a rare, benign tumor that occurs almost exclusively in adolescent males. It originates from the area around the sphenopalatine foramen and grows locally in an infiltrative manner, often extending into nearby structures like the nasal cavity, paranasal sinuses, and infratemporal fossa. While typically non-cancerous, it can be locally aggressive and in rare cases extend intracranially. Complete surgical removal is the primary treatment, though pre-operative embolization may help control blood loss.
Reinke's oedema
Benign polypoid degeneration of one or both the vocal folds leading to dysphonia.Smoking is the commonest predisposing factor.
Lateral sinus thrombophlebitis
Lateral sinus thrombophlebitis is an inflammation of the inner wall of the lateral venous sinus caused by infection from acute or chronic ear diseases. Bacteria enter the sinus and cause a thrombus formation within the sinus, obstructing drainage. Common symptoms include fever, headache, and papilledema. Diagnosis involves blood tests and imaging like CT or MRI. Treatment requires antibiotics, surgery to drain abscesses and remove clots, and sometimes anticoagulants or jugular vein ligation. Complications can include sepsis, meningitis, abscesses if not treated promptly.
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Juvenile papillomatosis
Juvenile papillomatosis is the most common benign laryngeal tumor in children, caused by HPV types 6 and 11. It is thought children contract it from their mothers during birth if the mother had HPV. Papillomas typically affect the supraglottic and glottic regions but can spread lower. Children who had tracheostomies are more likely to have tracheal and stoma involvement due to seeding. Symptoms include hoarseness, difficulty breathing, or stridor in children ages 3-5. Diagnosis is via laryngoscopy and biopsy. Treatment involves laser excision to remove papillomas while preserving the voice, but recurrence is common and requires repeated procedures.
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
This document discusses juvenile nasopharyngeal angiofibroma (JNA), a rare benign but invasive tumor that arises in adolescent males near the sphenopalatine foramen. JNA presents with nasal obstruction and epistaxis. Diagnosis involves imaging like CT and MRI to determine the extent of involvement. Treatment depends on staging and may include preoperative embolization, surgery such as endoscopic resection, or radiation for advanced cases. Complete resection aims to prevent recurrence while minimizing complications like bleeding, infection, and nerve damage.
JNA
The document discusses juvenile nasopharyngeal angiofibroma (JNA), a benign but locally invasive vascular tumor that primarily affects adolescent males. It arises near the sphenopalatine foramen and can spread medially into the nasopharynx and laterally into surrounding structures. Presentation varies from nasal obstruction to cranial nerve palsies. Imaging shows a hypervascular mass often with bone erosion. Diagnosis is confirmed histologically. Staging guides surgical approach, with endoscopic resection increasingly used for early-stage tumors. Complete resection while preserving function is the goal.
Tympanosclerosis
Tympanosclerosis is characterized by hyaline deposits in the tympanic membrane and middle ear space caused by chronic infection or inflammation. It results in the degeneration of connective tissue and deposition of calcium and phosphate. Common symptoms include conductive hearing loss and occasional tinnitus. Diagnosis is made by otoscopy showing white plaques and audiometry showing a conductive hearing loss. Treatment depends on the size and location of plaques, with small plaques sometimes removed before grafting but large plaques usually just addressed with hearing aids.
Juvenile nasopharyngeal angiofibroma
Juvenile nasopharyngeal angiofibroma is a rare, benign tumor that occurs almost exclusively in adolescent males. It originates from the area around the sphenopalatine foramen and grows locally in an infiltrative manner, often extending into nearby structures like the nasal cavity, paranasal sinuses, and infratemporal fossa. While typically non-cancerous, it can be locally aggressive and in rare cases extend intracranially. Complete surgical removal is the primary treatment, though pre-operative embolization may help control blood loss.
Reinke's oedema
Benign polypoid degeneration of one or both the vocal folds leading to dysphonia.Smoking is the commonest predisposing factor.
Lateral sinus thrombophlebitis
Lateral sinus thrombophlebitis is an inflammation of the inner wall of the lateral venous sinus caused by infection from acute or chronic ear diseases. Bacteria enter the sinus and cause a thrombus formation within the sinus, obstructing drainage. Common symptoms include fever, headache, and papilledema. Diagnosis involves blood tests and imaging like CT or MRI. Treatment requires antibiotics, surgery to drain abscesses and remove clots, and sometimes anticoagulants or jugular vein ligation. Complications can include sepsis, meningitis, abscesses if not treated promptly.
Endoscopic (DCR) Dacryocystorhinostomy
This presentation describes the causes and presentation of Epiphora and describe the technique of Endoscopic DCR surgery.
Glomus Tumour
Glomus tumours are benign, slow-growing, hypervascular tumours that originate from glomus bodies in the middle ear. They are most commonly seen in the 5th decade of life and affect females more often than males. On histology, they appear as clusters of cells arranged in a nested pattern surrounded by a vascular stroma. Surgical excision is the primary treatment, though pre-operative embolization of feeding vessels can help reduce blood loss. Glomus tumours can spread locally within the temporal bone and occasionally metastasize to distant sites like the lungs. Advanced cases may require a combined surgical and radiotherapy approach.
Perichondritis of the external ear
Perichondritis refers to inflammation of the perichondrium of the external ear. It is usually caused by trauma such as piercing or burns and the most common organisms involved are Pseudomonas aeruginosa and Staphylococcus aureus. The diagnosis is clinical based on signs of inflammation and pain in the cartilaginous ear. If left untreated, it can lead to abscess, avascular necrosis of cartilage, and deformity of the pinna. Treatment involves early use of broad-spectrum antibiotics, drainage of any abscesses, and conservative surgery if resistant including irrigation and excision of necrotic cartilage to preserve the structure of the ear.
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Nasal polyps are non-cancerous growths that can develop in the nose or sinuses. They are most common in people over 50 years of age and affect males more than females. Histologically, nasal polyps contain edema fluid and high numbers of eosinophil inflammatory cells. The most common sites for nasal polyps are the ethmoid and maxillary sinuses. Nasal polyps can cause symptoms like nasal obstruction, loss of smell, sneezing and headaches. Treatment involves steroid nasal sprays, oral steroids or surgery to remove the polyps.
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This document provides information on juvenile nasopharyngeal angiofibroma (JNA), a rare benign tumor that occurs mostly in adolescent males. JNAs originate from sex steroid-stimulated hamartomatous tissue in the nasal cavity. They are highly vascular tumors that can locally invade structures in the nasal cavity, paranasal sinuses, and skull base. Imaging like CT and MRI are used to determine the extent of disease. The Fisch staging system, which classifies JNAs into 4 types based on their extent, is commonly used to guide treatment planning.
Rhinolith
A rhinolith forms around a small foreign body introduced into the nose, causing inflammation and pus secretion high in calcium and magnesium. This allows mineral salts to precipitate over time, forming a stony mass. Rhinoliths typically cause unilateral nasal obstruction, foul discharge, pain, and ulceration. They appear on examination as an irregular, stony hard mass and can be seen on imaging tests. Rhinoliths are usually removed surgically under general anesthesia.
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- NPC originates from the epithelial lining of the nasopharynx.
- It has a strong association with Epstein-Barr virus.
- Risk factors include genetic predisposition and environmental exposures like salted fish consumption.
- Common symptoms are cervical lymphadenopathy, epistaxis, ear symptoms, and neurological deficits.
- Diagnosis involves biopsy and serological testing for EBV markers.
- Staging systems consider tumor size, node involvement, and serological factors.
- Primary treatment is radiotherapy,
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1) Endoscopic DCR is a minimally invasive procedure to treat nasolacrimal duct obstruction that avoids external incisions and scars.
2) Key steps include identifying bony landmarks to locate the lacrimal sac, making a bone window, inserting a silicone tube, and correcting any associated nasal pathology.
3) Advantages over external DCR include avoiding external scars, direct visualization allowing precise surgery and management of concurrent nasal issues, and lower risks of complications.
Tumours of nasopharynx (2) itp class dr.davis - 03.06.16
This document provides information on tumours of the nasopharynx, including a classification system dividing them into epithelial tumours, soft tissue tumours, bone/cartilage tumours, malignant lymphomas, and miscellaneous tumours. It also discusses juvenile nasopharyngeal angiofibroma, the most common benign nasopharyngeal tumour seen in young males. Nasopharyngeal carcinoma is also summarized, noting its association with Epstein-Barr virus and environmental/genetic risk factors in certain populations. The WHO pathological classification system for NPC divides it into three main types.
Nasopharngeal angiofibroma
1. Nasopharyngeal angiofibroma is a rare, benign tumor that occurs mostly in adolescent males and arises from the posterior nasal cavity.
2. It is locally invasive and can extend into surrounding areas like the nasal cavity, paranasal sinuses, and cranial cavity, causing symptoms like nasal obstruction, epistaxis, and cranial nerve palsies.
3. Diagnosis involves imaging like CT and MRI to determine the extent of the tumor. Surgical excision is the primary treatment but carries a risk of heavy bleeding, so preoperative embolization of feeding vessels is often used to reduce bleeding during surgery.
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Glomus Tumour
Glomus tumours are benign, slow-growing, hypervascular tumours that originate from glomus bodies in the middle ear. They are most commonly seen in the 5th decade of life and affect females more often than males. On histology, they appear as clusters of cells arranged in a nested pattern surrounded by a vascular stroma. Surgical excision is the primary treatment, though pre-operative embolization of feeding vessels can help reduce blood loss. Glomus tumours can spread locally within the temporal bone and occasionally metastasize to distant sites like the lungs. Advanced cases may require a combined surgical and radiotherapy approach.
Perichondritis of the external ear
Perichondritis refers to inflammation of the perichondrium of the external ear. It is usually caused by trauma such as piercing or burns and the most common organisms involved are Pseudomonas aeruginosa and Staphylococcus aureus. The diagnosis is clinical based on signs of inflammation and pain in the cartilaginous ear. If left untreated, it can lead to abscess, avascular necrosis of cartilage, and deformity of the pinna. Treatment involves early use of broad-spectrum antibiotics, drainage of any abscesses, and conservative surgery if resistant including irrigation and excision of necrotic cartilage to preserve the structure of the ear.
Atrophic rhinitis
This document discusses three chronic nasal diseases: atrophic rhinitis, rhinosporidiosis, and rhinoscleroma. Atrophic rhinitis causes nasal atrophy and foul odors. It can be primary from infection or nutritional factors, or secondary from other conditions like sinusitis. Rhinosporidiosis is caused by Rhinosporidium seeberi and presents as red nasal lesions. Rhinoscleroma is caused by Klebsiella rhinoscleromatis and presents in stages from rhinitis to fibrosis, commonly affecting the nose and spreading to other areas. Treatment involves antibiotics, surgery, or other measures depending on the specific condition.
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ENT Nasal septal perforation..... for best rhinoplasty and nose reshape surgery contact
Dr Junaid Ahmad (MBBS FCPS) is the best plastic surgeon in Lahore. He is a well known, trained and expert in his field. He is MBBS and FCPS in Plastic and Recosntructive Surgery. He is a post graduate of the College of Physicians and Surgeons Pakistan which is oldest and best institute for post graduation in this area of the world. He is doing his practice in Lahore, Pakistan. He is always kind to the patients and listens them carefully as it is part of modern clinical skill and training. He is expert in both cosmetic as well as reconstructive surgery. He is also skin cancer and burn expert. A few of Dr Junaid Ahmad expertise are listed here..... call 03104037071
Myringoplasty ppt
Myringoplasty is a procedure to repair a perforated eardrum using a graft without examining the middle ear. It aims to replace the missing fibrous layer and allow regeneration of skin and mucosa over the graft. The document discusses the indications, contraindications, surgical approaches, techniques, post-op care, complications and advantages/disadvantages of the underlay and overlay techniques. The key steps of underlay involve freshening the perforation edges, elevating the tympanomeatal flap, placing the graft under the flap and reposing the flap. Overlay places the graft over the remaining eardrum and covers it with the elevated skin.
Laryngeal tuberculosis
About 15-25 percent casesof pulmonary tuberculosis can have laryngeal tuberculosis however primary laryngeal TB is not rare.
Keratosis obturans
Keratosis obturans is a condition characterized by an accumulation of desquamated keratin in the external auditory meatus. It occurs when the normal migration of epithelium from the tympanic membrane to the posterior meatal wall is obstructed by wax or a foreign body, causing an abnormal separation of keratin. There are two main types - a silent type caused by this abnormal keratin separation, and an inflammatory type caused by acute ear canal inflammation. Clinically, it presents as a white keratin plug occluding the ear canal, sometimes with accompanying granulations or canal widening. Treatment involves removing the cause if present, using keratolytic agents, and potentially surgical removal under general anesthesia for recurrent cases
Functional endoscopic sinus surgery
The document discusses Functional Endoscopic Sinus Surgery (FESS). FESS is a minimally invasive procedure that uses an endoscope to access and treat the paranasal sinuses. It aims to restore sinus function by re-establishing ventilation and mucociliary clearance. Key steps in FESS include uncinectomy to remove the uncinate process, maxillary antrostomy to access the maxillary sinus, and ethmoidectomy to access the ethmoid sinuses. Proper identification of anatomical landmarks like the middle turbinate, uncinate process, and bulla ethmoidalis is important for successful FESS.
Nasal polyposis
Nasal polyps are non-cancerous growths that can develop in the nose or sinuses. They are most common in people over 50 years of age and affect males more than females. Histologically, nasal polyps contain edema fluid and high numbers of eosinophil inflammatory cells. The most common sites for nasal polyps are the ethmoid and maxillary sinuses. Nasal polyps can cause symptoms like nasal obstruction, loss of smell, sneezing and headaches. Treatment involves steroid nasal sprays, oral steroids or surgery to remove the polyps.
Maxillary sinus carcinoma
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Symposium Vocal Nodules And Polyp
The document discusses vocal nodules and polyps, which are benign growths on the vocal folds caused by vocal abuse or misuse. Vocal nodules are small lesions less than 3mm located at the front of the vocal folds, while polyps are larger lesions. Symptoms include hoarseness, vocal fatigue, and difficulty speaking. Treatment involves voice therapy, medical management, and surgery to remove the growths if they are large or not improving. Surgical complications can include scarring and loss of voice if the layers of the vocal folds are damaged during removal of the nodules or polyps.
Juvenile nasopharyngeal angiofibroma
This document provides information on juvenile nasopharyngeal angiofibroma (JNA), a rare benign tumor that occurs mostly in adolescent males. JNAs originate from sex steroid-stimulated hamartomatous tissue in the nasal cavity. They are highly vascular tumors that can locally invade structures in the nasal cavity, paranasal sinuses, and skull base. Imaging like CT and MRI are used to determine the extent of disease. The Fisch staging system, which classifies JNAs into 4 types based on their extent, is commonly used to guide treatment planning.
Rhinolith
A rhinolith forms around a small foreign body introduced into the nose, causing inflammation and pus secretion high in calcium and magnesium. This allows mineral salts to precipitate over time, forming a stony mass. Rhinoliths typically cause unilateral nasal obstruction, foul discharge, pain, and ulceration. They appear on examination as an irregular, stony hard mass and can be seen on imaging tests. Rhinoliths are usually removed surgically under general anesthesia.
Atrophic rhinitis.pptx
Atrophic rhinitis, also known as ozaena, is a chronic inflammation of the nasal mucosa that results in atrophy, squamous metaplasia, and crust formation. It is characterized by the atrophy of the nasal mucosa and turbinates, scanty viscid secretions, loss of ciliated columnar epithelium, and crust formation. The pathophysiology involves periarteritis and endarteritis of the nasal mucosa, decreasing blood supply and resulting in atrophy of mucous glands, epithelium, and metaplasia of the ciliated columnar epithelium. Treatment involves antibiotics, estrogen therapy, surgical procedures to narrow the nasal cavity and increase lubrication, and sal
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This document describes the indications, techniques, and postoperative care for septoplasty surgery. It indicates that septoplasty is performed to correct a deviated nasal septum causing obstruction or other issues. The key steps described are making an incision, raising mucoperichondrial flaps, removing deviated cartilage and bone, and re-approximating the flaps. Potential complications are also outlined.
Diseases of external ear
This document discusses diseases of the external ear. It begins by describing the anatomy of the external ear canal. It then categorizes conditions affecting the external ear into congenital, inflammatory, reactive, traumatic, and tumors. Under congenital conditions it discusses preauricular sinus, congenital ear swellings, fistulas and anomalies. It provides details on preauricular sinus including embryology, clinical features, management and associated syndromes. It also discusses other congenital conditions such as ear swellings, fistulas and atresia. The document further describes inflammatory conditions including erysipelas, perichondritis and malignant otitis externa. It also covers reactive, traumatic, and neoplastic conditions of the external
Rhinomanometry
This document discusses various methods for objectively measuring nasal patency and airflow, which is important for accurately assessing complaints of nasal obstruction. It describes rhinomanometry, which measures nasal resistance, and acoustic rhinomanometry, which provides anatomical data on nasal cross-sectional area. Several other tests are also mentioned, including peak nasal inspiratory flow, body plethysmography, and questionnaires. Overall, the document provides an overview of existing objective methods for evaluating nasal function and structure to help diagnose the cause of a blocked nose.
Nasopharyngeal Carcinoma
The document discusses the anatomy, histology, epidemiology, clinical features, diagnosis, staging, and treatment of nasopharyngeal carcinoma (NPC). Key points include:
- NPC originates from the epithelial lining of the nasopharynx.
- It has a strong association with Epstein-Barr virus.
- Risk factors include genetic predisposition and environmental exposures like salted fish consumption.
- Common symptoms are cervical lymphadenopathy, epistaxis, ear symptoms, and neurological deficits.
- Diagnosis involves biopsy and serological testing for EBV markers.
- Staging systems consider tumor size, node involvement, and serological factors.
- Primary treatment is radiotherapy,
Endoscopic dcr
1) Endoscopic DCR is a minimally invasive procedure to treat nasolacrimal duct obstruction that avoids external incisions and scars.
2) Key steps include identifying bony landmarks to locate the lacrimal sac, making a bone window, inserting a silicone tube, and correcting any associated nasal pathology.
3) Advantages over external DCR include avoiding external scars, direct visualization allowing precise surgery and management of concurrent nasal issues, and lower risks of complications.
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Juvenile angiofibroma is a rare, benign and highly vascular tumor that develops almost exclusively in adolescent males within the sphenopalatine foramen. It presents with recurrent severe nosebleeds and progressive nasal obstruction. Imaging such as CT and MRI are used to determine the extent of the tumor. While surgery is the primary treatment, preoperative embolization and endoscopic resection are often used for early-stage tumors to reduce bleeding and complications. Advanced tumors may require open approaches like mid-facial degloving. Recurrence rates remain high due to the invasive nature of the tumor.
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1) Rathke's pouch forms the pituitary gland, which must migrate to the hypothalamus during development. In some individuals, pituitary tissue remains in the roof of the pharynx.
2) Down syndrome results from trisomy 21 and is characterized by midface hypoplasia, reducing nasopharynx and oropharynx volume.
3) Crouzon syndrome is an autosomal dominant craniosynostosis with midface hypoplasia and relative mandibular prognathism, potentially causing airway obstruction.
juvenile nasopharyngeal angiofibroma.pptx
Juvenile nasopharyngeal angiofibroma is a rare benign tumor that affects adolescent males. It is locally aggressive and grows in the nasal cavity and nasopharynx. The tumor is highly vascular and can extend to surrounding areas like the pterygopalatine fossa, infratemporal fossa, and intracranially. Treatment involves preoperative embolization followed by surgical resection through an endoscopic or open approach depending on tumor extent. Close postoperative monitoring is needed due to the risk of recurrence.
Angiofibroma
1. Juvenile nasopharyngeal angiofibroma is a rare, benign tumour that occurs primarily in adolescent males and is highly vascular.
2. It originates from the posterior nasal cavity near the sphenopalatine foramen and can extend into local structures like the sinuses, orbit and cranium.
3. Treatment involves preoperative embolization followed by surgical excision via various approaches depending on tumour extent. Endoscopic removal is used for smaller tumours while more extensive approaches are needed for larger or invasive tumours.
ORAL MALIGNANCIES M.pptx
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This document discusses hypopharyngeal cancer. Some key points:
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- Presentation includes sore throat, dysphag
BENIGN NEOPLASMS OF THE NOSE AND PNS.pptx
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hypopharyngealcancer2-151012175726-lva1-app6892.pptx
1. Hypopharyngeal cancers arise from the mucosa of the hypopharynx and are often advanced at diagnosis due to late onset of symptoms.
2. Risk factors include smoking, alcohol use, and HPV infection. Tumors most commonly arise from the pyriform sinus.
3. Diagnosis involves endoscopy, imaging, and biopsy to assess primary tumor size and spread to lymph nodes. Most are squamous cell carcinomas.
Glomus tumours pakistan
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Epistaxis & Angiofibroma.pptx
Blood Supply of Nose
Little’s Area & Importance
Causes & Classification of Epistaxis
Management of Epistaxis
Angiofibroma and its Etiology
Pathology of Angiofibroma
Diagnosis of Angiofibroma
Treatment of Angiofibroma
Epistaxis & Angiofibroma.pptx
Blood Supply of Nose
Little’s Area & Importance
Causes & Classification of Epistaxis
Management of Epistaxis
Angiofibroma and its Etiology
Pathology of Angiofibroma
Diagnosis of Angiofibroma
Treatment of Angiofibroma
Situated in the anterior inferior part of nasal septum.
Four arteries anastomose here to form a vascular plexus “Kiesselbach’s Plexus”
Usual site for Epistaxis in children & young adults.
Another plexus of veins is situated inferior to posterior end of inferior turbinate, called “Woodruff’s Plexus”. It is a site of posterior epistaxis.
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Tumours of nasopharynx (2) itp class dr.davis - 03.06.16
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Jna(juvenile nasopharyngeal angiofibroma) current treatment modalities
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Juvenile nasopharyngeal angiofibroma
- 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
- 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.
- 23. THANK YOU