Endonasal endoscopic management of juvenile nasopharyngeal angiofibroma without angiographic embolization.

The objective of the study was to present our experience with definitive endonasal endoscopic management of patients with Radkowski stage IA&B and IIA Juvenile nasopharyngeal angiofibroma (JNAs) without preoperative angiographic embolization. This was a retrospective study performed at tertiary referral center. 18 males with JNAs stage IA&B and II A according to Radkowski classification were included in this study. Their ages ranged from 14 to 23 years with a mean of 16.7 years. All patients were presented by nasal obstruction with recurrent epistaxis in 15 patients. All the patients underwent computed tomography and magnetic resonance imaging to delineate the extent and location of the tumor. Neither angiography nor embolization was done for any patient preoperatively. An endonasal endoscopic technique was used for excision of the tumors in all patients. Complete removal of the tumor was achieved in 16 patients with no residual or recurrent tumor. Two patients had residual tumors: the recurrence in the lateral wall of the sphenoid sinus in the first patient and in the pterygopalatine fossa in the other patient. Follow-up ranged from 14 to 72 months with a mean of 37.4 months. The mean of intraoperative blood loss was 342.3 ± 92.7 ml. The endonasal endoscopic approach is a safe and effective technique for small- and intermediate-sized JNAs (stage IA&B and IIA) without preoperative angiographic embolization. Hypotensive anesthesia, meticulous dissection as well as diathermy of the sphenopalatine artery greatly decrease the blood loss.

Functional endoscopic sinus surgery in children: predictive factors of outcome.

The main objective of this study is to assess the results of functional endoscopic sinus surgery in children and to determine which factors independently influence the postoperative results. It is a prospective study by Mansoura University Hospital. 87 patients with different applications of pediatric endoscopic sinus surgery (PESS) chronic rhinosinusitis (CRS) with nasal allergy (45 patients), CRS without nasal allergy (36 patients) and CRS with polypsis (6 patients) from 2005 to 2010 were included. All children underwent endoscopic sinus surgery. All patients were clinically, radiologically and endoscopically monitored. In this study, the overall success rate was 87.69%, the success rate for CRS with nasal allergy was 87.5%, the success rate for CRS without nasal allergy was 85.7% and the success rate for CRS with polyposis was 93%. Regarding the patients' age, it could affect the surgical score value (X(2) = 9.446 and P* = 0.009). There was significant relation between type of the preoperative disease extent, adenoidectomy, second look operation and postoperative improvement. There was no significant relation between type of the preoperative disease or previous surgery and postoperative improvement. In conclusion, postoperative improvement was significantly correlated with extent of preoperative disease, adenoidectomy and second look operation and not significantly correlated with type of the preoperative disease or previous surgery. The results of PESS are influenced by age group, a younger age group is associated with more adhesions and recurrences and an older age group is associated with blood loss and higher surgical score. All these variables are contributing in the outcome of PESS.

Transnasal endoscopic management of recurrent juvenile nasopharyngeal angiofibroma.

OBJECTIVES: The purpose of this study was to present our experience with definitive endoscopic surgical management of the recurrent juvenile nasopharyngeal angiofibroma. STUDY DESIGN: Retrospective study. SETTING: Tertiary care centre. MATERIALS AND METHODS: This study includes 13 male adolescence patients with recurrent nasopharyngeal angiofibroma who received treatment at our centre between 2005 and 2010. The patient age ranged from 12 to 21 years (mean age, 15.7 years). Endoscopic two surgeons' technique had been used. Follow up MRI every four months. RESULTS: Complete removal of the recurrent tumor was achieved in 10 cases. Three patients had incomplete removal with further recurrences. These recurrences were two in lateral wall of the sphenoid sinus (2 patients), and soft palate (one patient). CONCLUSION: Recurrent JNAs are residual disease resulting from incomplete removal of the primary tumor. Transnasal endoscopic sinus surgery is an effective method for treating recurrent JNA. Follow up is essential and integral point in management of JNAs.

Urgent maxillectomy in infants for rare infantile maxillary tumors.

OBJECTIVE: The purpose of this study was to present our experience with definitive surgical management of infants with Melanotic neuroectodermal tumor of infant (MNTI) and epithelioid hemangioendothelioma (EHE). PATIENTS AND METHODS: This study included four male infants with histologically proven MNTI (three infants) and EHE (one infant). CT scan and MRI were for taken for the patients preoperatively. Surgical intervention was used in all infants. RESULTS: This study is a retrospective study that reflects our experience in the last 20 years in maxillectomy in infants. All infants were male with mean age 6 months (2-9 months). Complete resection of the tumor was achieved all infants with no residual or recurrence. Neither chemotherapy nor radiation was used in this study. CONCLUSIONS: MNTI and EHE are rare tumor of infant. They present as a slow painless hard swelling of the maxilla. Imaging is an essential before surgical treatment. Complete excision is curative.