Endoscopic Transnasal Resection of a Juvenile Angiofibroma Using an Ultrasonically Activated Scalpel

Abstract

We report a case of juvenile nasopharyngeal angiofibroma (JNA). A 19-year-old male came to our clinic complaining of severe nasal obstruction and epistaxis. Imaging investigations using computed tomography and magnetic resonance imaging techniques revealed a soft tissue mass in the nasopharynx with minimal extension to the pterygopalatine fossa. After embolization of the internal maxillary artery, we successfully performed endoscopic transnasal surgery for a JNA using an ultrasonically activated scalpel. Endoscopic follow-up for the 18 months after the surgical procedure revealed no evidence of recurrence or residual tumor.

Endoscopic Surgery for Juvenile Angiofibroma: When and How

“…Including the present series, approximately 100 cases of JA treated by endonasal approach have been reported in the literature [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] ; thus, this procedure cannot be considered as a "standard" technique. Therefore, patients who undergo such a treatment require careful follow-up evaluation for the early detection of possible residual lesions.…”

“…Several surgical options, including transhyoid, transpalatal, transfacial (through a lateral rhinotomy or a midfacial degloving), and infratemporal approaches, have been advocated. Recent reports have focused on more conservative transnasal treatments, using either purely endoscopic 5–20 or combined microscopic–endoscopic techniques. 21,22 …”

“…Several surgical options, including transhyoid, transpalatal, transfacial (through a lateral rhinotomy or a midfacial degloving), and infratemporal approaches, have been advocated. Recent reports have focused on more conservative transnasal treatments, using either purely endoscopic [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] or combined microscopic-endoscopic techniques. 21,22 From January 1992 to September 2002, in all, 101 benign and malignant lesions of the sinonasal tract or nasopharynx was managed by an endoscopic approach at the Department of Otolaryngology of the University of Brescia (Brescia, Italy).…”

Endoscopic approach to juvenile nasopharyngeal angiofibroma: our experience at a tertiary care centre

“…3 Many authors have reported their preliminary experiences of the removal of such tumours, either endoscopically or endoscope-assisted following conventional surgery. 4 -24 Endoscopic tumour removal can be assisted by electrocautery, 3,22 laser, 15,19 ultrasonic activated scalpel, 17 image-guided surgery and frozen section pathological analysis. 19 We report our experience of endoscopic exposure and excision of juvenile nasopharyngeal angiofibroma.…”

Endoscopic resection of the submandibular gland via a hairline incision: A new surgical approach

“…9 The ultrasonically activated scalpel is effective at providing good hemostasis and minimizing injury to important structures, 5 and it is more effective in preventing bleeding than stopping bleeding. 24 This device provided better visualization of the operative field, with the absence of smoke, char, and odor. 5 The backside of the hook blade was usually used for the dissection; however, the coagulating shears were used when bisecting the vascular structures.…”