SURGICAL MANAGEMENT AND OUTCOME OF JUVENILE

NASOPHARYNGEAL ANGIOFIBROMA IN A SINGLE

CENTRE: A FIFTEEN YEAR EXPERIENCE


Jeyasakthy Saniasiaya, Baharudin Abdullah, Ramiza Ramza Raml
Department Of Otorhinolaryngology-head & Neck Surgery, School Of Medical Sciences, Universiti Sains Malaysia Health Campus,
16150 Kota Bharu, Kelantan, Malaysia

By :
M. Ikhsanul Fikri
Wirjapratama Putra
Ridha Faisal
Yeri Estu
Nursida Islami

Department of Ear, Nose and Throat

Faculty of Medicine University of Riau
2018
 Introduction
Juvenile nasopharyngeal angiofibroma (JNA):


 a locally aggressive benign vascular tumour

 exclusively amongst adolescence males

 Originate from the superior aspect of the sphenopalatine foramen

 Age distribution of this entity is between 14 and 25 years

Comprises of 0.5 % of all head and neck tumour

The most common benign tumour of nasopharynx

Introduction

 Introduction Nasal Obstruction

Common clinical
presentation Epistaxis

Nasopharyngeal
mass

There are relation Biopsies are not recommended because of the

between these angiomas vascular and hemorrhagic nature of this
and androgen- tumour. Endoscopy approach is the current
dependent. cornerstone of management
 Methodology

15 years retrospective study(2000-2015) fully conducted in Hospital
Universiti Sains Malaysia amongst 11 patients

The fisch criteria applied to classify tumour based on CT findings

 Result
Clinical presentation includes unilateral spontaneous painless epistaxis


(35%), unilateral nasal obstruction (34%), nasal discharge (19%), voice
changes (6%) and ocular symptoms and abnormal facial contour seen
amongst 3% each
Fisch staging
Stage Description

I Tumours limited to nasal cavity, nasopharynx with no

18%
bony destruction
II Tumours invading the pterygomaxillary fossa,
paranasal sinuses with bony destruction 46%

III Tumours invading the infratemporal fossa, orbit and

parasellar region, remaining lateral to the cavernous 9%
sinus
IV Tumours with invasion to the cavernous sinus, optic
27%
chiasmal region and pituitary fossa
 Result

There is no association seen between duration of symptoms and staging

No association were noted between the staging and type of surgical

approach

64% of recurrence were noted amongst our patients. No association

were seen between staging of the disease and recurrence and type of
surgery and recurrence
 Discussion

Juvenile
nasopharyngeal
angiofibroma is an In this study, all patients
entity amongst were male with a mean age
adolescence male upon presentation being 15
years which is similar to
other published study
 Discussion

Radhowski mentioned
that close to 70% of
patients are at Stage II This is similar to this
upon presentation patients as mostly
presented at Stage II upon
diagnosis (46%)
 Discussion


Preoperative embolization is All embolizations were performed in

advocated prior to surgery in a single session with a pre-
many centres. embolization angiogram to analyse
and determine extent of tumour
blush, feeding arteries, draining
veins and extracranial to intracranial
anastomosis
 Discussion

Surgery remains
the first line
treatment in most Similarly, all our
centres. patients were
subjected to surgery.
 Discussion

Transmaxillary route is
favoured by many surgeons
as it is said to have better Our patients were subjected to
exposure, lower morbidity transnasal endoscopic approach
and no facial scar and a combined approach which
comprises of two different open
approach to facilitate resection
 Discussion

Recurrence is estimated to occur up
to 46% within six months
postoperatively. Study by Liu et al.
showed a significant association
between staging and recurrence In our centre, the recurrence rate id 64%
whereby higher recurrence were and it is postulated that the possible cause
observed with stage III and IV among others includes patients delay in
surgical decision and inadequate
embolization
 Discussion

Study by Reddy et al.
demonstrated that
radiotherapy is just as
effective as surgery as a In our centre, only 2 patients
primary treatment modality were subjected to radiotherapy,
with a 15% recurrence rate both patients with recurrence,
one with intracranial extension
and the other refused surgery.
 Discussion

Chemotherapy has been
said to be used as an
alternative or an adjunct
when recurrence is seen In our centre, only one patient
following surgical with recurrence underwent
treatment combined radiotherapy and
chemotherapy
 Discussion

Another treatment modality is hormonal therapy which
is said to reduce the size and vascularity of
angiofibroma via antiandrogen effect for instance
flutamide, but is poorly tolerated due to its physical
and psychological side-effects notably feminization
effect
 Conclusion

Based on our observation, surgery combined with pre-
operative embolization is the main modality of treatment in our
centres.

However, inadequate embolization, patients delay and refusal of

surgery has led to a significant recurrent rate in our centre.
 

Thank you