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

Abstract

These modified techniques, performed with endoscopic assistance under hypotensive anaesthesia, without embolisation, offer a superior option over other open procedures with regard to morbidity and recurrences.

Assisted resection of lateral extension of juvenile nasopharyngeal angiofibroma using a sphenopalatine fossa dissector

“…Regarding our institutional experience using this device, in a cohort of 63 JNA cases that primarily underwent transpalatal excision from 2012 to 2015, there was a recurrence in 3 cases and residual disease in 2 cases 4 . This is much lower than our archival recurrence rate of 17.59 per cent in cases that underwent similar transpalatal techniques without this device, from 1972 to 2014 3 Table I.…”

“…Finally, in order to assess the efficacy of the new device, we compared the recurrence rates before and after 2012 at our institution. Specifically, we compared the previously published data for 3 years (2012 to 2015) in cases where the device was used 4 with our archival data of 400 cases operated on before 2012 without the device 1 . It is worth mentioning again that the transpalatal approach is a routine practice at our facility and more than 90 per cent of JNA cases managed at our department undergo this technique.…”

“…Our encouraging surgical results using this device with transpalatal excision have been reported previously. 4 This paper presents the evolution of the surgical design and establishes its novelty.…”

Posterior Nasal Pack After Transpalatal Excision of Juvenile Nasopharyngeal Angiofibroma: Can It be Avoided?

“…Since JNA is more often seen in less privileged countries, our modification may be adapted to further ease the transpalatal approach. The reader is encouraged to read an exclusive article in defence of transpalatal approaches for JNA [4] in this regard that is especially applicable to the third world which caters a higher burden than the west. The presented modification may not be of much relevance for the institutions preferring pure endoscopic approach, but will certainly be important for the majority of centres across the globe where facilities of endoscopic excision are yet unavailable and transpalatal approach is carried out as a routine.…”

Juvenile Angiofibroma: Current Management Strategies

“…The transpalatal approach has been largely abandoned as it affords poor exposure for large tumors, resulting in a greater chance of recurrence. However, Mishra et al 23 recently presented their experience on the resection of 63 JAs using modified transpalatal approaches. A transpalatal-circumaxillary approach, where the incision is extended to the retromolar area to expose the pterygoid plates and PPF, was appropriate for tumors involving the PPF and medial ITF, while a transpalatal-circumaxillary-sublabial approach, where the incision is extended to include the sublabial region, was appropriate for tumors involving the ITF, cheek, and even the temporal fossa.…”