Authors: Anna Szymańska Marcin Szymański Elżbieta CzekajskaChehab Małgorzata SzczerboTrojanowska
Publish Date: 2014/03/06
Volume: 272, Issue: 1, Pages: 159-166
Abstract
Juvenile nasopharyngeal angiofibroma is a benign locally aggressive nasopharyngeal tumor Apart from anterior lateral extension to the pterygopalatine fossa it may spread laterally posterior to the pterygoid process showing posterior lateral growth pattern which is less common and more difficult to identify during surgery We analyzed the routes of lateral spread modalities useful in its diagnosis the incidence of lateral extension and its influence on outcomes of surgical treatment The records of 37 patients with laterally extending JNA treated at our institution between 1987 and 2011 were retrospectively evaluated Computed tomography was performed in all patients and magnetic resonance imaging in 17 46 patients CT and MRI were evaluated to determine routes and extension of JNA lateral spread Anterior lateral extension to the pterygopalatine fossa occurred in 36 97 patients and further to the infratemporal fossa in 20 54 patients In 16 43 cases posterior lateral spread was observed posterior to the pterygoid process and/or between its plates The recurrence rate was 297 11/37 The majority of residual lesions was located behind the pterygoid process 7/11 Recurrent disease occurred in 3/21 patients with anterior lateral extension in 7/15 patients with both types of lateral extensions and in 1 patient with posterior lateral extension JNA posterior lateral extension may spread behind the pterygoid process or between its plates The recurrence rate in patients with anterior and/or posterior lateral extension is significantly higher than in patients with anterior lateral extension only Both CT and MRI allow identification of the anterior and posterior lateral extensionsJuvenile nasopharyngeal angiofibroma JNA is a vascular tumor that originates in the sphenopalatine foramen at the area of the pterygoid canal aperture 1 The disease is rare accounting for 005 of all head and neck tumors and most often occurs in adolescent males 2 3 4 5 6 JNA is a unique clinical problem due to the controversy regarding its exact nature pathogenesis and best treatment option for most advanced tumorsAlthough benign JNA behaves aggressively extending to the adjacent areas From its site of origin the tumor grows medially to the nasopharynx where it usually becomes symptomatic Some tumors spread laterally to the pterygopalatine fossa and with further growth to the infratemporal fossa JNAs with large lateral extension in the infratemporal fossa and cheek without medial spread to the nasopharynx are very rare 7Expanding tumor may also grow along the skull base posterior to the pterygoid process which may lead to parapharyngeal space involvement This type of lateral growth should be identified as a posterior lateral extension in contrast to the anterior lateral extension in the pterygopalatine fossa which is more common and easier to identify during surgery Extranasopharyngeal extensions of JNA include also the nasal cavity paranasal sinuses the orbit and in advanced cases also the craniumSurgical removal is the gold standard treatment for extracranial angiofibromas 5 6 8 Extranasopharyngeal extensions may increase the risks of surgical treatment due to potential complications of wide surgical exposure intraoperative hemorrhage and recurrence In this context the problem of the posterior lateral extension is of particular interestThe aim of this study was to analyze radiological findings of JNA patients with lateral extension with special attention given to routes of lateral spread and modalities useful in its diagnosis The incidence of lateral spread and its influence on planning and outcomes of surgical treatment were also discussedA retrospective chart review of 47 patients with juvenile nasopharyngeal angiofibroma referred to our institution between 1987 and 2011 was performed The records of 37 patients with tumors extending laterally from the nasopharynx were included in the study The study was approved by the institutional ethical committeeAll patients in the selected group were males The age ranged from 9 to 30 years the median age was 16 years Most common presenting symptoms were nasal obstruction in 34 of 37 patients 92 and epistaxis in 32 of 37 patients 86 Additional complaints were facial swelling in four patients and proptosis in two patients The duration of symptoms ranged from 2 to 24 months
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