Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent males. Surgery remains the primary treatment of choice. JNA has always presented a management challenge to surgeons because of its vascular nature, site of occurrence, and local tissue destruction. The surgical approaches are either standard open method which include external or intraoral incisions, or the recent advanced approach, i.e. via using the endonasal endoscope. It is widely accepted that the use of preoperative angiographic embolization reduces the occurrence of intraoperative bleeding and facilitates tumour removal. However, angiographic embolization is not available at all centres. The purpose of this article is to present our experience with five patients diagnosed with JNA who were resected without embolization, using various surgical approaches. Two tumours were removed via endonasal endoscopic surgery. None of the tumours were embolized prior to surgery. We highlight the preoperative evaluation of tumour extent, using both computed tomography (CT) and magnetic resonance angiography, and the importance of temporary clamping of the external carotid artery intraoperatively. Our results suggest that the latter procedure is a safe and effective means of facilitating surgery and reducing intraoperative bleeding.
Shifting the paradigm of treatment of a locally recurrent nasopharyngeal carcinoma (NPC) from the non-surgical management to a surgical modality has always been a challenge. However, many studies on endoscopic nasopharyngectomy have proven it to be a reliable form of treatment with an excellent outcome. Since 2007, in Sarawak General Hospital, six cases of endoscopic nasopharyngectomy for locally recurrent NPC have been performed with encouraging results.
Traditional open approaches to the nasopharynx either provide limited access and risk significant morbidity. Here we describe our experience with endoscopic resection of nasopharyngeal tumours. Retrospective chart review was performed for all patients who underwent endoscopic nasopharyngeal resection from September 1993 to January 2007 at a tertiary rhinology centre. Six patients underwent endoscopic nasopharyngectomy for tumours arising from or involving the nasopharynx. The mean age was 49.8 years (range 23 - 70). The sex distribution was five males and one female. Four tumours were malignant and two were benign. The mean disease-free and overall survival for malignant tumors was 90.75 months (range 66 - 120 months). None of the benign tumors recurred. The endoscopic nasopharyngectomy technique may be successfully used for resection of tumors arising from or involving the nasopharynx with good efficacy and a decrease in morbidity when compared to open approaches.
Hemangiopericytoma is a very rare angiogenic tumor. In the nasal cavity, it can be considered malignant. It occurs in various parts of the body but those in the nasal cavity account for only 5% of total cases. Less than 200 cases have been reported worldwide involving the nose and paranasal sinuses. Due to its rarity a proper line of management has not been established to tackle this tumour. This article highlights two cases of hemangiopericytoma (HPC), one in an adult and the other in a child, presenting as an intranasal mass.
This is a retrospective study that aimed to examine the outcomes of patients presenting with juvenile nasopharyngeal angiofibroma (JNA) at a tertiary centre in Malaysia.
Acute stridor is often an airway emergency. We present a valuable experience handling an elderly woman who was initially treated as COVID-19 positive during the pandemic in November 2020. She needed an urgent tracheostomy due to nasopharyngeal (NP) diffuse large B-cell lymphoma causing acute airway obstruction. Fortunately, 1 hour later, her NP swab real-time PCR test result returned as SARS-CoV-2 negative. This interesting article depicts the importance of adequate preparations when handling potentially infectious patients with anticipated difficult airway and the perioperative issues associated with it.