Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign

Abstract

Imaging plays an important role in the diagnosis, staging and prognosis of JNA. Certain radiological changes as seen on CECT were observed to be consistent in our case series. This study analysed preoperative and postoperative CECT of large series of JNA patients to evaluate the sites and pattern of spread of tumor. We evaluated the clinical significance of pterygoid wedge in preoperative and postoperative imaging and thus elucidating two new radiological signs. Retrospective analysis of the pre operative and post operative imaging data of 242 patients with JNA. The findings in the scan were clinically correlated with the endoscopic intraoperative findings. Preoperative evaluation of the pterygoid wedge revealed widening on the involved side in 99.1% of our cases which is 1.8 times greater compared to the uninvolved side. The possibility of residual/recurrent tumor was found to be significantly higher in those where the pterygoid wedge was not removed by drilling (p \ 0.001) Drilling of the pterygoid wedge intra operatively, reduced the rate of residual/recurrence from 31.9 to 3.07%. Widening of the pterygoid wedge seen in the preoperative CECT, referred as RAM HARAN sign occurs in JNA. It has a significant diagnostic value as a radiological sign in JNA. Drilling of the pterygoid wedge intraoperatively reduces the rate of recurrence of JNA. Appearance of the two pterygoid plates on postoperative CECT, as two parallel lines, referred as Chopstick sign, has a remarkable prognostic value as a radiological sign in JNA.

Twenty Years of Experience in Juvenile Nasopharyngeal Angiofibroma (JNA) Preoperative Endovascular Embolization: An Effective Procedure with a Low Complications Rate

“…PIAE is the current most accepted treatment for JNA, minimizing intraoperative bleeding and reducing surgical morbidity [15,17,21,22]. This technique not only reduces the blood supply to the lesion, but the diagnostic preoperative digital subtraction angiography (DSA) highlights the JNA specific vascularization patterns, guiding the surgeon to plan the approach and to delineate lesion areas of increased bleeding risk [15,23].…”

Juvenile nasopharyngeal angiofibroma

“…В настоящее время этот признак не считается специфическим для ЮАН. Расширение клина крыловидных отростков при ЮАН, видимое при МСКТ-исследовании, описывается как знак Рам Харан (Ram Haran) (рисунок 6) [54].…”

“…Клин крыловидных отростков справа расширен. Знак Рам Харан (Ram Haran) [54]. Прилежащие костные структуры разрушены опухолью Coronal contrast-enhanced MSCT in a patient with JNA.…”

“…The pterygoid wedge is widened on the right. The Ram Haran sign [54]. The adjacent bones are destroyed by the tumor тельны при обнаружении лептоменингеального распространения [86].…”

“…По данным других литературных источников считается, что местом исходной локализации ЮАН является область клиновидно-небного отверстия и/ или крыловидно-небной ямки (рисунок 1) [49][50][51][52][53]. Не менее заслуженные авторы с мировым именем в области хирургии ЮАН на основе анализа своего опыта (242 пациента с ЮАН) предполагают, что губчатая кость основания крыловидных отростков может являться исходным местом локализации опухоли [54]. Большое количество клинических наблюдений демонстрируют первично нетипичную экстраназофарингеальную локализацию ЮАН [55][56][57][58][59][60][61][62][63][64][65][66][67][68].…”