outcome review of conventional surgical treatment of angiofibroma

ABSTRACT

To determine the efficacy of conventional surgical treatment for juvenile nasopharyngeal angiofibroma, in terms of morbidity and recurrence. A descriptive study This study was conducted at ENT, Unit I, Allama lqbal Medical College/Jinnah Hospital, Lahore, from September 2007 to September 2010. Fifty patients with juvenile nasopharyngeal angiofibroma treated surgically were analyzed. For each patient, data were obtained regarding the symptoms, extension of the Lesion, various surgical approaches and rate of recurrence. Preoperatively, all the patients were evaluated with detailed history, endoscopic nasal cavity and nasopharyngeal examination and computed tomography. Age gender, main symptom leading to consultation, any previous surgical treatment performed, various surgical approaches, duration of hospital stay and recurrence were evaluated. Follow-up examinations were performed in the first, three and six months postoperatively. All patients had CT scan after 6 months interval to rule out any recurrence. All the 50 patients were male either adults or adolescents. The age of the patients ranged from seventeen years. The most common symptom was nasal obstruction with repeated episodes of epistaxis, seen in a the patients The other associated symptoms seen were nasal discharge snoring in 20%, headache in 10%, speech detects [rhinolalia clausa] in 20%, facial asymmetry in 40%, deafness unilateral [on the side of disease] in 10%, bilateral in 10% and orbital pain in 10% of the patients. The clinical examination demonstrated mass in the nasopharynx in all patients [100%], and nasal fossa in 30 patients [60%]. The other less common signs included external nasal deformity in 10%, palatal displacement in 20%, cheek swelling in 40%, proptosis in 20% and conductive deafness in 20%. Lateral rhinotomy Transmaxiliary via midfacial degloving and Lateral rhinotomy and Subtemporal preauricular infratemporal fossa approach was used in 22%, 60% and 18% patients respectively. In 6 patients tracheotomy was done per operatively and all of them were decanulated after removal of pack. Per operative exposure and temporary closure of external carolid artery was done in 8 patients who had extensive disease and bleeding pre-operatively. Five units of whole blood were arranged for each patient pre-operatively. Hypotensive anesthesia was used in all patients to minimize the blood loss. The blood loss ranged from 150 ml to 2.3 liters with an average loss of 400 ml. The average duration of hospital stay was 15 days, with shortest stay of 8 days with the maximum stay of 32 days. All patients had a minimum follow up for six months. 8 patients had recurrence for which they were operated again Conventional surgical procedures still have their place in the treatment of the JNF