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Endoscopic laser-assisted excision of juvenile nasopharyngeal angiofibromas.

Abstract

BACKGROUND

Juvenile nasopharyngeal angiofibromas (JNAs) are highly vascular tumors that originate in the nasopharynx of young males. The primary treatment is surgical excision. Traditional surgical approaches are associated with significant morbidity and facial deformity. We introduce and outline the clinical advantages of an endoscopic surgical approach to JNAs using the Nd:YAG laser with image-guided surgery.

DESIGN

Case series.

SETTING

Tertiary care medical center.

PATIENTS AND METHODS

Our study included 5 male patients (age range, 8-21 years) with extensive JNAs. Their tumors were large and ranged from Fisch stage IIA to IIIA. Embolization of tumor-feeding vessels was performed before surgery. The tumors were photocoagulated via a transnasal endoscopic approach using a Nd:YAG laser. Devascularized, lased tumor was removed with a microdebrider. Image-guided navigation systems were used to assist skull base tumor removal, and sublabial and buccolabial incisions were used as needed to gain lateral endoscopic tumor access. Endoscopic tumor margins were obtained for frozen section.

RESULTS

All patients achieved symptomatic remission, with no complications. No blood transfusions were necessary. The patients were ready for discharge 1 to 2 days after surgery. Postoperative and magnetic resonance imaging scans showed 2 skull base recurrences, which were removed endoscopically. Follow-up ranged between 2 and 3 years.

CONCLUSIONS

Traditional external surgical approaches to large JNAs may result in significant morbidity. Laser-assisted image-guided endoscopic excision of JNAs is a safe and effective minimally invasive surgical treatment. Its distinct advantages include (1) diminished blood loss, (2) superior cosmesis without observed altered facial growth, (3) direct access of skull base with minimal morbidity, and (4) ease of endoscopic follow-up.

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  • Authors+Show Affiliations

    ,

    Otolaryngology Service, Walter Reed Army Medical Center, Washington, DC, USA. eric.mair@lackland.af.mil

    ,

    Source

    MeSH

    Adolescent
    Adult
    Age Factors
    Angiofibroma
    Child
    Endoscopy
    Humans
    Laser Therapy
    Male
    Nasopharyngeal Neoplasms
    Outcome Assessment (Health Care)

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    12707194

    Citation

    Mair, Eric A., et al. "Endoscopic Laser-assisted Excision of Juvenile Nasopharyngeal Angiofibromas." Archives of Otolaryngology--head & Neck Surgery, vol. 129, no. 4, 2003, pp. 454-9.
    Mair EA, Battiata A, Casler JD. Endoscopic laser-assisted excision of juvenile nasopharyngeal angiofibromas. Arch Otolaryngol Head Neck Surg. 2003;129(4):454-9.
    Mair, E. A., Battiata, A., & Casler, J. D. (2003). Endoscopic laser-assisted excision of juvenile nasopharyngeal angiofibromas. Archives of Otolaryngology--head & Neck Surgery, 129(4), pp. 454-9.
    Mair EA, Battiata A, Casler JD. Endoscopic Laser-assisted Excision of Juvenile Nasopharyngeal Angiofibromas. Arch Otolaryngol Head Neck Surg. 2003;129(4):454-9. PubMed PMID: 12707194.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Endoscopic laser-assisted excision of juvenile nasopharyngeal angiofibromas. AU - Mair,Eric A, AU - Battiata,Andrew, AU - Casler,John D, PY - 2003/4/23/pubmed PY - 2003/5/8/medline PY - 2003/4/23/entrez SP - 454 EP - 9 JF - Archives of otolaryngology--head & neck surgery JO - Arch. Otolaryngol. Head Neck Surg. VL - 129 IS - 4 N2 - BACKGROUND: Juvenile nasopharyngeal angiofibromas (JNAs) are highly vascular tumors that originate in the nasopharynx of young males. The primary treatment is surgical excision. Traditional surgical approaches are associated with significant morbidity and facial deformity. We introduce and outline the clinical advantages of an endoscopic surgical approach to JNAs using the Nd:YAG laser with image-guided surgery. DESIGN: Case series. SETTING: Tertiary care medical center. PATIENTS AND METHODS: Our study included 5 male patients (age range, 8-21 years) with extensive JNAs. Their tumors were large and ranged from Fisch stage IIA to IIIA. Embolization of tumor-feeding vessels was performed before surgery. The tumors were photocoagulated via a transnasal endoscopic approach using a Nd:YAG laser. Devascularized, lased tumor was removed with a microdebrider. Image-guided navigation systems were used to assist skull base tumor removal, and sublabial and buccolabial incisions were used as needed to gain lateral endoscopic tumor access. Endoscopic tumor margins were obtained for frozen section. RESULTS: All patients achieved symptomatic remission, with no complications. No blood transfusions were necessary. The patients were ready for discharge 1 to 2 days after surgery. Postoperative and magnetic resonance imaging scans showed 2 skull base recurrences, which were removed endoscopically. Follow-up ranged between 2 and 3 years. CONCLUSIONS: Traditional external surgical approaches to large JNAs may result in significant morbidity. Laser-assisted image-guided endoscopic excision of JNAs is a safe and effective minimally invasive surgical treatment. Its distinct advantages include (1) diminished blood loss, (2) superior cosmesis without observed altered facial growth, (3) direct access of skull base with minimal morbidity, and (4) ease of endoscopic follow-up. SN - 0886-4470 UR - https://www.unboundmedicine.com/medline/citation/12707194/Endoscopic_laser-assisted_excision_of_juvenile_nasopharyngeal_angiofibromas L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/vol/129/pg/454 DB - PRIME DP - Unbound Medicine ER -