Juvenile Nasopharyngeal angiofibroma (JNA)
Endoscopic SkullBase Surgery
Juvenile Nasopharyngeal angiofibroma (JNA)
JNA is a benign but locally aggressive vascular tumour that grows in the back of the nasal cavity. It most commonly affects adolescent males. Onset is most commonly in the second decade; the range is 7-19 years. JNA is rare in patients older than 25 years.
The tumour starts adjacent to the sphenopalatine foramen. They initially fill the nasal cavity and nasopharynx. The tumour can extend superiorly towards the sphenoid sinus. The cavernous sinus may become invaded if the tumour advances further. Laterally, the tumour extends through the pterygopalatine fossa, bowing the posterior wall of the maxillary sinus, into the infratemporal fossa. Extending through the orbital fissures can cause proptosis and optic nerve atrophy.
Symptoms of JNA
- Patients usually present with
- Frequent unprovoked profuse nasal bleed
- Nasal obstruction and nasal discharge
- Facial swelling
- Conductive hearing loss from eustachian-tube obstruction
- Double vision, which occurs secondary to erosion into superior orbital fissure and due to third and sixth nerve palsy,
- Protrusion of eye when the tumour extends into the orbit.
Investigations
CT as well as MRI is done to know the extent of this highly vascular tumour. Biopsy should be avoided as to avoid extensive bleeding since the tumour is composed of blood vessels without a muscular coat. To reduce the blood loss during surgery, angiography is done to block the artery that supplies blood to the tumour and is known as embolization (Fig. 1 & 2).
Selective angiogram of sphenopalatine artery shows the vascularity of the tumour
Selective angiogram of sphenopalatine artery shows complete occlusion of tumour blood vessels.
Treatment
Treatment for Nasopharyngeal angiofibroma (JNA) is primarily surgical. In the past, tumour was exposed through the mouth or by making incisions in the face (transpalatal, lateral rhinotomy, transmaxillary, maxillary swing and mid-face degloving approaches). Currently, advanced endoscopic sinus & skull base surgery techniques have been used successfully to remove these tumours. Considerable surgical experience is required to successfully perform the endoscopic operation.
The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)
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The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)