PRINCIPLES OF SURGICAL TREATMENT OF JUVENILE NASOPHARYNGEAL ANGIOIBROMA:
The primary treatment of Juvenile Nasopharyngeal Angiofibroma is Surgical removal. Our team of experienced ENT – Head and Neck Surgeon at Adventis ENT make use of the latest technology and techniques to ensure that the tumour can be removed completely and efficiently and with minimal morbidity to the patient.
The advent of proper pre-operative embolization, endoscopic cameras, thermo-surgical devices and use of Coablation Technology in our setup has definitely improved complete tumour removal and decreased the morbidity and mortality of the routinely performed surgeries for extensive JNA.
What are the different ways and techniques we can surgically remove a JNA ?
- Endoscopic approach – Use of endoscope passed through the nostril , thus avoiding external incision and scars.
- Open approach – Reaching the tumour by making an incision on the nose or face
- Combined approach – combination of endoscopic with open approach
How do we decide which approach is best for you ?
- Size and location of the tumour
- Pattern of blood supply of the tumour
- Expertise of the treating team.
- Effective preoperative Angiography and embolization.
- Facial skeletal maturity of the patient
ENDOSCOPIC TECHNIQUE OF EXCISION OF JNA:
Endoscopic removal is great for Small localised tumour with minimal extension or as an adjunct to open approach.
The advantage is that there is no external scar in an exclusive endoscopic approach, it causes less morbidity, lesser chance of ICU Stay and allows you early discharge from hospital.
It may Not be apt for large extensively spread tumour. In this situation we may discuss the necessity of conversion to an open approach (combined approach) if we anticipate that the removal may be incomplete.
OPEN EXTERNAL APPROACH:
This may be the preferred treatment for large extensively spread tumours or recurrent tumours or as an adjunct to endoscopic approach. It does provide better access to tumour. Yes, this may result in a fine facial scar or handling of the facial skeleton; but this may be advised to you in the best interest of the patient. Examples of external approaches are :
- Lateral Rhinotomy approach: Entry and access to tumour is made via an incision at the side of the nose.
- Transpalatal approach: Entry and access to tumour is made by breaking through the palatal bone.
- Anterior Approach / Mid Facial Degloving approach/Le Fort 1 approach: Entry toward tumour made by down fracturing the cheek bone.
- Maxillary swing: The tumour behind the cheek bone is approached by temporarily removing the cheek bone and replacing it back, after resection of JNA, with plates and screws.
- Infratemporal with transcranial approach: Done along with Neurosurgical support to resect extensive tumours spreading from the nasal area through the skull base and into the skull.
Our experienced team of ENT – Head and Neck Surgeon at Adventis ENT will be happy to discuss any concerns you may have with the management of Juvenile Nasopharyngeal Angiofibroma and the best combination of treatment modalities suited to you.