Angiofibromas of the postnasal space: A critical appraisal of various therapeutic modalities

Abstract

Angiofibromas of the postnasal space are an enigma to the treating surgeon in view of their extensions around the skull base. The availability of modern investigative procedures has to some extent facilitated the decision making process in choosing a suitable surgical approach.Proper tumour staging and the earliest and widest possible exposure tailored to the needs of the specific situation together with adequate blood replacement is the key to success in minimizing the chances of the recurrence.The present study aims at an evaluation of the methodology adopted in 100 serial cases of angiofibromas of the postnasal space. After initial surgery, a further 31 procedures were needed for the management of recurrences.

Critical Look at the Surgical Approaches of Nasopharyngeal Angiofibroma Excision and “Total Maxillary Swing” as a Possible Alternative

“…A significant reduction in hemorrhage was observed by Economou et al 7 after ligation of the external carotid artery in the resection of larger tumors and tumors with intracranial extension. Conventional surgical approaches used in larger reported series also were followed by recurrences and complications (Table 2 7,11,[21][22][23][24][25] ).…”

In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma

“…The surgical procedure currently practised at our centre is a combination of two techniques, as previously described by Sardana 5 and Mishra et al, 6 which is suitable for the majority of large extensions ( Figure 1). The surgical procedure currently practised at our centre is a combination of two techniques, as previously described by Sardana 5 and Mishra et al, 6 which is suitable for the majority of large extensions ( Figure 1).…”

“…The surgery was performed only by the faculty consultants (AM, VV, HPS and SK). The surgical procedure currently practised at our centre is a combination of two techniques, as previously described by Sardana 5 and Mishra et al ., 6 which is suitable for the majority of large extensions (Figure 1). The classical transpalatal incision can be extended more anteriorly in the form of a tongue-shaped flap if needed.…”

Surgical Management of Juvenile Nasopharyngeal Angiofibroma Using Lateral Rhinotomy: Study of 80 Cases

“…The early failures of the head and neck surgeons to resect the highly vascular lesion due to the lack of imaging and appropriate anesthesia techniques stimulated interest in alternative methods like radiotherapy, chemotherapy and hor-monal therapy. 2 None of these proved successful in managing the tumor. However, with the advent of computed tomography (CT), magnetic resonance imaging (MRI), angiography and newer techniques of hypotensive anesthesia, there has been renewed interest in surgical management of JNA.…”