Ans : C.)Nasopharyngeal Angiofibroma
- It is a histologically benign but locally aggressive vascular tumor that grows in the back of the nasal cavity.
- It is the most common benign neoplasm of nasopharynx.
- It is a highly vascular tumor.It consists of fibrous tissue and blood vessels,
- Blood supply of the tumor most commonly arises from the internal maxillary artery.
- The exact cause is unknown. As the tumour is predominantly seen in adolescent males in the second decade of life, it is thought to be testosterone dependent.
- Such patients have a hamartomatous nidus of vascular tissue in the nasopharynx and this is activated to form angiofibroma when male sex hormone appears.
- Most common site is posterior part of nasal cavity close to the margin of sphenopalatine foramen.
- It may expand into the surrounding areas like nasal cavity,sphenoid sinus,pterygopalatine fossa,maxillary sinus,orbit and cranial cavity.
CLINICAL PRESENTATION OF NASOPHARYNGEAL ANGIOFIBROMA
- Sex : Seen almost exclusively in males (testosterone dependent).
- Age : 10-20 years (2nd decade).
- Clinical features: – Most common symptom is profuse and recurrent epistaxis Progressive nasal obstruction
- Other features depending upon the extension of the tumour:
- Denasal speech(Rhinolalai clausa)
- Conductive hearing loss and serous otitis media due to eustachian tube blockage
- Broadening of nasal bridge
- Soft palate may bulge due to a large mass in late stages
- Frog-face deformity
- Swelling of cheek
- Involvement of cranial nerves II, Ill, IV, VI
INVESTIGATIONS IN A CASE OF NASOPHARYNGEAL ANGIOFIBROMA
- Radiography:it shows a soft tissue shadow in the nasopharynx.
- Lateral view shows forward displacement of the posterior wall of maxilla.
- Angiography and CT Scan with contrast deomonstrate the extent and vascularity of the tumor.
- Biopsy should never be attempted as it may lead to profuse bleeding.
- Instead,Excision biopsy is performed.
TREATMENT OF NASOPHARYNGEAL ANGIOFIBROMA
- Surgical excision is the treatment of choice.
- Before surgery at least 2-3 liters of blood should be given.
- Preoperative embolization and estrogen therapy or cryotherapy reduce blood loss in surgery.
- Hypotensive Anesthesia in nasopharyngeal angiofibroma is/are given by Propofol and Phentolamine.
- Wilson’s Transpalatine approach—done for tumor confined to nasopharynx.
- Lateral rhinotomy approach—done for large tumors involving, nasal cavity, paranasal sinuses and orbit.
- Other approaches:
- Sardana’s approach – Transpalatine + Sublabial.
- Extended Lateral Rhinotomy
- Intracranial combined with Extracranial.
- Infratemporal fossa approach.
- It is sometimes advised to reduce the vascularity of the tumor.
- It may be considered in cases with intracranial extension.
- It is doubtful if tumour regression occurs with this therapy.