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Kochaji N, Beit ZK, Alissa R, Mezael B, Gouriea G, Othman I. Intraosseous angio-lipo-fibroma of the mandible: Report of a rare case with review of literature. Int J Surg Case Rep 2024; 119:109651. [PMID: 38701613 PMCID: PMC11078641 DOI: 10.1016/j.ijscr.2024.109651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Angiolipofibroma is rare lesion with extraordinarily vascular structure, occurs within the head and neck region, typically springing up in the nasopharyngeal location, with a locally competitive efficiency. CASE PRESENTATION Male patient, aged 25 years old was referred to oral surgeon with the aim of surgical removal of a painless lesion of the left posterior mandibular area. he has well heath without any medical history The mass was removed by the oral surgeon and subjected to histological analysis the final diagnosis was found to be an intraosseous angiolipofibroma. CLINICAL DISCUSSION The significance of this report lies in the rarity of the presence of angiolipofibroma in the mandible and the clinical and radiographic manifestations were only a silent unilocular radiolucent lesion. Only a few cases have been published describing angiolipofibroma in the mandible. it is difficult to diagnose on clinical and radiographic features only. CONCLUSION The definitive diagnosis is based on histological examination. The surgical treatment was enough.
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Affiliation(s)
- Nabil Kochaji
- Oral Histology & Pathology Department, Faculty of Dentistry, Damascus University, Damascus, Syria.
| | - Zafin Kara Beit
- Oral Maxillofacial Surgery Department, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Rami Alissa
- Oral Histology & Pathology Department, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Bashar Mezael
- Oral Maxillofacial Surgery Department, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - George Gouriea
- Oral Histology & Pathology Department, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Iman Othman
- Preventive Oral Medicine Specialist, Damascus University, Damascus, Syria
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2
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Gerlach R, Modesti CL, Rampinelli V. Interdisciplinary Management of Skull Base Tumors. Laryngorhinootologie 2024; 103:S28-S42. [PMID: 38697142 DOI: 10.1055/a-2196-8984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
OBJECTIVE Endoscopic endonasal skull base surgery has gained acceptance worldwide. Comparative analysis has demonstrated that endoscopic skull base surgery may have advantages for many pathologies of the anterior skull base, e. g., sinonasal malignant tumors; pathologies of the central skull base, e. g., pituitary adenomas, craniopharyngiomas; well-selected cases of planum sphenoidale and tuberculum sellae meningiomas; or for clival lesions, e. g., chordomas, chondrosarcomas, or selected meningiomas. Over the past three decades, interdisciplinary surgical teams, consisting of otolaryngologists and neurosurgeons, have provided detailed anatomical knowledge, suggested new approaches or modifications of established surgical techniques, and offered continued surgical education. METHOD A review of pertinent literature was conducted with an emphasis on interdisciplinary endoscopic surgery of skull base lesions. RESULTS Based on the authors̓ surgical experience in two different interdisciplinary endoscopic skull base centers, the authors classify approaches for endoscopic endonasal skull base surgery, describe indications, and key anatomic landmarks for common pathologies, and highlight surgical techniques to avoid complications. CONCLUSION Interdisciplinary endonasal endoscopic surgery combines surgical expertise, improves resection rates for many pathologies, and minimizes morbidity by reducing the incidence of surgical complications.
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Affiliation(s)
| | - Claudia Lodovica Modesti
- Unit of Otolaryngology and Head and Surgery, ASST Spedali Civili di Brescia, University of Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otolaryngology and Head and Surgery, ASST Spedali Civili di Brescia, University of Brescia, Italy
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3
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Endoscopic, endoscopic-assisted and open approaches in the treatment of juvenile angiofibroma: what has been new in the past decade (and 1586 cases)? Eur Arch Otorhinolaryngol 2023; 280:2081-2089. [PMID: 36683103 DOI: 10.1007/s00405-023-07824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/14/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Juvenile angiofibroma (JA) is a benign, but locally invasive tumor of the nasopharynx. Surgical resection of JA is performed through endoscopic (EA), endoscopic-assisted (EAA), or open approaches (OA). The management of these tumors is constantly evolving. We aimed to compare the surgical efficiency and morbidity of EA, EAA, and OA in JA treatment by conducting a systematic review of the literature published over the last 10 years. METHODS A systematic review of the English literature on surgical cases of JA published between 2012 and 2022 was performed. Eligible articles were analyzed for individual patient data (IPD) and aggregate patient data (APD). The primary predictor variable was the surgical approach. The primary outcome variable was recurrence rate. RESULTS The search retrieved 75 articles reporting 1586 JA surgical cases; 129 in IPD, and 1457 in APD data sets. Within the IPD data set, recurrence rates were significantly lower in cases completed by EA than that by OA (p < 0.05). There was no significant difference in recurrence rates between the EA and EAA groups (p > 0.05). EAA had a lower recurrence rate than that of OA (p < 0.05). For the APD data set, the recurrence rate following EA was significantly lower than that following OA (p < 0.05). There was no significant difference in recurrence between the EA and EAA groups (p > 0.05), and between the EAA and OA groups (p > 0.05). CONCLUSIONS EA represents the method of choice for mild and moderately advanced JA. EAA and OA still play important roles in the treatment of advanced-stage JA.
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Rizwan S, Huang TC, Koong B, Bynevelt M, Stamatis J, Goonewardene R. Incidental finding of juvenile angiofibroma from pre-orthodontic radiographs: two case reports and a literature review. Aust Dent J 2022; 67:281-285. [PMID: 35152431 PMCID: PMC9790401 DOI: 10.1111/adj.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/20/2021] [Accepted: 02/07/2022] [Indexed: 12/30/2022]
Abstract
This case series presents two asymptomatic cases of juvenile angiofibroma which were initially incidentally identified in pre-orthodontic radiographs. Juvenile angiofibroma is an uncommon, locally aggressive benign, vascular neoplasm with invasive growth patterns. Due to the hypervascularity of these tumours, there are biopsy associated risks and multi-slice computed tomography, magnetic resonance imaging and angiography are usually employed for diagnosis. Early pre-symptomatic identification of this lesion facilitates early management and limiting potential life-threatening complications. This highlights the importance of thorough interpretation of dental radiographs, including the evaluation of structures which are not in the primary region of interest. © 2022 Australian Dental Association.
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Affiliation(s)
- S Rizwan
- School of DentistryThe University of QueenslandHerstonQueenslandAustralia
| | - TC Huang
- Private PracticePerthWestern AustraliaAustralia
| | - B Koong
- Private PracticePerthWestern AustraliaAustralia,School of Human Science, Faculty of ScienceThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - M Bynevelt
- The Neurological Intervention & Imaging Service of Western Australia at Sir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - J Stamatis
- Private PracticePerthWestern AustraliaAustralia
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5
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Jadhav S, Khandaitkar S, Mitra K, Chaudhari S, Dhok AP. Juvenile Nasopharyngeal Angiofibroma: An Aberrant Case Report. Cureus 2022; 14:e24350. [PMID: 35607527 PMCID: PMC9124007 DOI: 10.7759/cureus.24350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/05/2022] Open
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6
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Angiofibroma of the Mandible: Report of a Rare Case. Case Rep Dent 2022; 2022:7779338. [PMID: 35425646 PMCID: PMC9005274 DOI: 10.1155/2022/7779338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Angiofibroma is an uncommon, highly vascular benign lesion that occurs in the head and neck region, typically arising in the nasopharyngeal area, potentially with a locally aggressive course. Angiofibroma with a primary intraoral presentation is extremely rare; few case reports have been published in the literature, with only three cases of angiofibroma in the mandible published to date. In this case, a 37-year-old man presented with swelling at the right mandible and underwent enucleation of the lesion under general anesthesia. After 1-year follow-up, there were no signs of recurrence.
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7
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Aversa A, Al-Mefty O. The Utilization of the Cranio-Orbital Zygomatic Approach for the Resection of Juvenile Nasopharyngeal Angiofibroma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e44-e45. [PMID: 34982915 DOI: 10.1227/ons.0000000000000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
Juvenile angiofibroma is a rare benign expansive lesion typically affecting young men. Surgery is the current mainstay of treatment. Because it is a very vascular lesion, preoperative transarterial embolization can decrease intraoperative bleeding.1,2 Transmaxillary or transpalatal approaches were used for totally extracranial lesions. Endonasal endoscopic resection became wildly used for radical excision with limited morbidity.2 In large lesions with intracranial extension and cavernous sinus involvement (Fisch type 4), purely anterior approaches (endoscopic or transmaxillary) can be associated with significant carotid artery and cranial nerves injuries and excessive hemorrhage from internal carotid artery supply that cannot be eliminated by preoperative embolization.3 Subtotal resection has been preconized in such cases, but tumor progression, cranial nerves and vision compromise, and major nasal postoperative bleeding could ensue. Radiotherapy of residual tumor has been associated with long-term complications, particularly given the young age of these patients.2 The cranio-orbital zygomatic approach provides an excellent exposure to the extensions into the middle fossa, anterior fossa, cavernous sinus, paranasal sinus, and infratemporal fossa components of large angiofibromas.4-6 It is particularly advantageous in the early interruption of the cavernous carotid feeders that are not amenable to safe embolization, rendering the tumor devascularized and bloodlessly resected. This article demonstrates the details and the advantages of this approach in a 13-year-old adolescent boy operated in 1997 for giant juvenile angiofibroma with extension in the middle fossa and the parasellar space with major vascularization from the cavernous carotid artery. The guardian consented to the procedure and publication of images. Image at 3:05 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, © LWW, 1998. Image at 3:25 from Arnautović KI, Al-Mefty O, Angtuaco E. A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms. Surg Neurol. 1998;50(6):504-520; © Elsevier, 1998. Used with permission. Image at 9:21 reprinted from Kempe LG and Krekorian EA,6 with permission from John Wiley and Sons, © 1969 The Triological Society.
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Affiliation(s)
- Antonio Aversa
- Division of Neurosurgery, National Institute of Cancer, Rio de Janeiro, Brazil.,Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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8
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Ferrari M, Cazzador D, Taboni S, Trimarchi MV, Emanuelli E, Nicolai P. When is a multidisciplinary surgical approach required in sinonasal tumours with cranial involvement? ACTA ACUST UNITED AC 2021; 41:S3-S17. [PMID: 34060516 PMCID: PMC8172110 DOI: 10.14639/0392-100x-suppl.1-41-2021-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022]
Abstract
The term “sinonasal tumours” includes a large spectrum of diseases, which are characterized by heterogeneous biological behavior and prognosis, and located in a critical anatomic area. Diagnosis and treatment of sinonasal tumours require the contribution of different disciplines. A narrative review was performed to highlight the role of surgeons in contributing to a multidisciplinary approach to sinonasal tumours. Diagnosis and staging of sinonasal tumours is challenging and requires collaboration between surgeons, radiologists, and pathologists. The identification and management of critical extensions (orbital or intracranial encroachment, vascular abutment or encasement) is fundamental for successful treatment. Most cases of advanced sinonasal tumours can undergo surgical intervention by an adequately trained otorhinolaryngological team. The contribution of neurosurgeons and oculoplastic surgeons is required in selected scenarios. In rare circumstances, multidisciplinary reconstructive strategies can be indicated for complex tissue defects. Furthermore, a multidisciplinary approach is pivotal in the management of perioperative complications. While surgery remains the mainstay of treatment, the role of non-surgical adjuvant or even exclusive treatments is constantly expanding.
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Affiliation(s)
- Marco Ferrari
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy.,Technology for Health (PhD program), Department of Information Engineering, University of Brescia, Brescia, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada
| | - Diego Cazzador
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Vittoria Trimarchi
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
| | - Enzo Emanuelli
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology, Head and Neck Surgery, University of Padua, "Azienda Ospedaliera di Padova", Padua, Italy
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Bignami M, Pietrobon G, Arosio AD, Fazio E, Nocchi Cardim L, Strocchi S, Molinaro S, Agosti E, Karligkiotis A, Battaglia P, Castelnuovo P, Giorgianni A. Juvenile Angiofibroma: What Is on Stage? Laryngoscope 2021; 132:1160-1165. [PMID: 34374999 DOI: 10.1002/lary.29801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of the present study is to validate and compare four of the most widely used staging systems for juvenile angiofibroma on a homogeneous cohort of patients. STUDY DESIGN Retrospective case series. METHODS A retrospective review of patients treated with endoscopic or endoscopic-assisted surgical resection between 1999 and 2020 was carried out. Each case was classified according to the following staging systems: Andrews-Fisch (1989), Radkowski (1996), University of Pittsburgh Medical Center (2010), and Janakiram (2017). Spearman's rank correlation test and areas under the curve of receiver operator curves were used to assess the correlation between outcomes of interests (blood loss, surgical time, need for transfusion, and persistence of disease) and stage of disease. RESULTS Seventy-nine patients were included, with a median follow-up time of 25 months (range 12-127 months). Median surgical time was 217 minutes (range 52-625). Median blood loss was 500 mL (range 40-5200) and 27 patients (34.2%) required blood transfusions. Seven patients (8.9%) showed persistence of disease. All classification systems showed a similar association with blood loss, surgical time, persistence of disease, and need for transfusion. CONCLUSIONS Involvement of the infratemporal fossa and intracranial extension was identified as red flags for surgical planning and preoperative counseling, as associated with increased risk for transfusion and persistent/recurrent disease, respectively. No classification system was found to be better than the others in predicting the most important outcomes. Therefore, the simplest and most easily applicable system would be the preferred one to be used in clinical practice. LEVEL OF EVIDENCE Level 4 case series Laryngoscope, 2021.
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Affiliation(s)
- Maurizio Bignami
- Department of Otorhinolaryngology, Department of Surgery, ASST Lariana, University of Insubria, Como, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giacomo Pietrobon
- Department of Head and Neck Surgery and Otorhinolaryngology, European Institute of Oncology IRCCS, Milan, Italy
| | - Alberto D Arosio
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Enrico Fazio
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Larissa Nocchi Cardim
- Department of Radiology, ASST Sette Laghi, Del Ponte Hospital, Varese, Italy.,Department of Neuroradiology, ASST Sette Laghi, Circolo Hospital, Varese, Italy
| | | | - Stefano Molinaro
- Department of Neuroradiology, ASST Sette Laghi, Circolo Hospital, Varese, Italy
| | - Edoardo Agosti
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Apostolos Karligkiotis
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Paolo Battaglia
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Paolo Castelnuovo
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Andrea Giorgianni
- Department of Neuroradiology, ASST Sette Laghi, Circolo Hospital, Varese, Italy
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10
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Kluthcovsky LC, Queiroz TNDL, Somensi M, Castro JLC, Engracia Filho JR. Angiofibroma of the Nasal Cavity in a Dog: Case Report. Top Companion Anim Med 2021; 44:100530. [PMID: 33636377 DOI: 10.1016/j.tcam.2021.100530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 11/15/2022]
Abstract
Nasopharyngeal angiofibroma is a histologic benign but locally aggressive vascular tumor described in humans. The description of this disease in dogs is limited. A mixed-breed female dog was presented with a history of epistaxis and nasal discharge. Rhinoscopy and computed tomography revealed a soft-tissue mass obstructing the entire nasal cavity, choana, maxillary recess, and right frontal sinus, but there was no bone or lymph node involvement. Histopathologic evaluation revealed irregular groups of blood vessels within a stroma of connective tissue, with secondary inflammation. Immunohistochemistry showed strong vimentin staining, mild factor VIII-related antigen staining, and negative staining for S100. The patient underwent tumor resection with fenestration surgery through the right maxillary bone, and there was tumor recurrence one year after surgery. This case report describes new findings regarding the immunohistochemical evaluation of nasopharyngeal angiofibroma in a dog. The laboratory and imaging findings, associated with a long-term follow-up, reinforce similar features between human and canine angiofibroma and may serve as a basis for immunohistochemical evaluation of this tumor in dogs.
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Affiliation(s)
- Lucas Cavalli Kluthcovsky
- Postgraduate Program in Animal Science, School of Life Sciences, Pontifical Catholic University of Parana (PUCPR), Curitiba, PR, Brazil.
| | - Thayana Neiva de Lima Queiroz
- Postgraduate Program in Animal Science, School of Life Sciences, Pontifical Catholic University of Parana (PUCPR), Curitiba, PR, Brazil
| | - Malena Somensi
- Postgraduate Program in Animal Science, School of Life Sciences, Pontifical Catholic University of Parana (PUCPR), Curitiba, PR, Brazil
| | - Jorge Luiz Costa Castro
- Postgraduate Program in Animal Science, School of Life Sciences, Pontifical Catholic University of Parana (PUCPR), Curitiba, PR, Brazil
| | - Jair Rodini Engracia Filho
- Postgraduate Program in Animal Science, School of Life Sciences, Pontifical Catholic University of Parana (PUCPR), Curitiba, PR, Brazil
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Szyfter W, Balcerowiak A, Gawęcki W, Juszkat R, Wierzbicka M. Juvenile nasopharyngeal angiofibroma-20 years of experience in endoscopic treatment. Otolaryngol Pol 2021; 75:9-14. [PMID: 33949314 DOI: 10.5604/01.3001.0014.5220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Juvenile nasopharyngeal angiofibroma is a rare, benign tumor; however, it shows local aggression and leads to profuse nosebleeds. <br/>Aim: The aim of the study is to present 20 years of experience in endoscopic treatment of this tumor. <br/>Material and methods: The material covers 71 patients treated in the years 1985-2019 at the Department of Otolaryngology and Laryngological Oncology in Poznań. In these patients, either the classic external approach, or the double approach - external with the use of endoscopes, or only the endoscopic approach was used. In the entire population, external surgeries were performed in 37 patients, double access in 8 and endoscopic access in 26 patients. <br/>Results: Complete resection of the tumor was achieved in 51 patients (72%). The remaining 20 patients (28%) had a residual or recurrent tumor and all of these patients underwent reoperation.<br/> Conclusions: The endoscopic approach with the use of various optics and navigation allows for the removal of not only small tumors but also much more advanced ones. Pre-operative evaluation of imaging results is extremely important to avoid incomplete tumor removal. Individual development of an operating strategy, a wide range of optics and various surgical methods, and especially endoscopic ones, are the guarantee of therapeutic success.
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Affiliation(s)
- Witold Szyfter
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Andrzej Balcerowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Robert Juszkat
- 2 Department of General and Procedural Radiology of the Poznan University of Medical Sciences, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
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12
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Linxweiler M, Yilmaz U. [Current perspectives on imaging and treatment of juvenile angiofibromas : A review]. Radiologe 2021; 60:1013-1017. [PMID: 33025135 DOI: 10.1007/s00117-020-00754-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CLINICAL ISSUE Juvenile angiofibroma is a benign tumor, whose surgical treatment may be complicated due to intraoperative hemorrhage. The tumors appear as well circumscribed, reddish masses, which often extend into the complete nasal cavity and nasopharynx. STANDARD RADIOLOGICAL METHODS Diagnosis is based on computed tomography (CT) and magnetic resonance imaging (MRI) with angiography to identify supplying blood vessels. STANDARD TREATMENT Open resection. INNOVATION IN TREATMENT The endoscopic endonasal resection is the therapy of choice and may be combined with open surgery after endovascular embolization. Radiation or hormone therapy are alternatives for patients with very advanced tumors or high surgical morbidity. Depending on location and age of the patients, residual tumors after surgery can be watched only or treated with radiotherapy. PERFORMANCE Preoperative endovascular embolization lowers intraoperative blood loss by about 70%, induces tumor shrinkage, and facilitates resection. The endonasal approach will lower the peri- and postoperative morbidity. RECOMMENDATION An endonasal approach combined with preoperative endovascular embolization should be preferred over open resection, but requires expertise as well as modern endoscopy and navigation equipment. MRI follow-ups should be performed regularly until after puberty. Recurrence after puberty is very uncommon.
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Affiliation(s)
- Maximilian Linxweiler
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Umut Yilmaz
- Klinik für diagnostische und interventionelle Neuroradiologie, Gebäude 90.4, 66421, Homburg, Deutschland.
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Jaiswal AS, Kumar R, Thakar A, Kumar R, Verma H, Bhalla AS, Kairo AK, Kakkar A, Chandra Sharma S, Sakthivel P. Plasma ablation-assisted endoscopic excision versus traditional technique of endoscopic excision of juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol 2020; 139:110410. [PMID: 33022553 DOI: 10.1016/j.ijporl.2020.110410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Juvenile nasopharyngeal angiofibroma is the vascular and locally aggressive tumor of the posterior nares and nasopharynx. Endoscopic excision is the preferred surgical modality in early Radkowski stages. The prime challenge is intraoperative bleeding. Literature is in favor of the use of plasma ablation to overcome surgical challenges. OBJECTIVE To evaluate the effectiveness of plasma ablation technique in the surgical management of juvenile nasopharyngeal angiofibroma. MATERIALS AND METHODS The current study recruited 36 patients of clinico-radiologically diagnosed cases of primary JNA of stage I and II (Modified Radkowski). In prospective arm, 18 consecutive patients were recruited, who underwent plasma ablation assisted endoscopic excision. In retrospective arm, 18 consecutive patients who underwent excision by traditional endoscopic instruments in the past two years, were recruited. Both the groups were compared for baseline characteristics, intraoperative blood loss, duration of surgery, length of hospital stay, and recurrence rates. RESULTS The use of plasma ablation decreased overall blood loss by 338 ml (mean difference) which was not statistically significant (p = 0.26). On subgroup analysis, the use of plasma ablation significantly decreased mean blood loss (648 ml, p = 0.046) and duration of surgery (83 min, p < 0.001) in patients who underwent embolization. No statistically significant difference was noted between two groups in length of hospital stay (p = 0.36) and recurrence rates (p = 0.64). CONCLUSION Plasma ablation is an effective technique available to decrease blood loss and duration of surgery during endoscopic excision of post embolized stage I and II patients of JNA.
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Affiliation(s)
- Avinash Shekhar Jaiswal
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Rakesh Kumar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Alok Thakar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Hitesh Verma
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ashu Seith Bhalla
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Arvind Kumar Kairo
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
| | - Suresh Chandra Sharma
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Pirabu Sakthivel
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
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14
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Schreiber A, Ravanelli M, Ferrari M, Mattavelli D, Rampinelli V, Bolzoni Villaret A, Bertazzoni G, Tomasoni M, Gualtieri T, Zorza I, Farina D, Maroldi R, Nicolai P. Early Postoperative Magnetic Resonance in the Diagnosis of Persistent Juvenile Angiofibroma. Laryngoscope 2020; 131:E2436-E2441. [PMID: 33245803 DOI: 10.1002/lary.29293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES/HYPOTHESIS Despite improvements in the treatment of juvenile angiofibroma (JA), the rate of persistence (pJA) is still not negligible. In the present study, we assessed the value of early postoperative magnetic resonance imaging (MRI) in depicting unintentional pJAs and designed a MRI-driven decisional flow-chart for pJA management and follow-up. STUDY DESIGN Observational study. METHODS Patients undergoing early postoperative MRI after endoscopic resection of JA in the Unit of Otorhinolaryngology - ASST Spedali Civili, University of Brescia from 2007 to 2017 were enrolled. MRI was defined as negative or positive based on defined radiological criteria. The diagnostic performance of MRI was evaluated. RESULTS The analysis included 26 patients, with a mean age of 16.5 years (range, 11-25). Early MRI was negative for pJA in 21 (80.8%) patients and positive in five (19.2%). No patient with a negative finding was found positive at subsequent follow-up MRIs. The accuracy of a positive finding was confirmed by pathologic examination (three cases) or follow-up MRIs (two cases). The diagnostic performance of MRI was excellent with sensitivity and specificity of 100%. An MRI-driven flow-chart for pJA management and follow-up was designed. CONCLUSIONS Early postoperative MRI demonstrated a high diagnostic accuracy in the detection of unintentional pJA. Our MRI-driven strategy and decisional flow-chart could aid in the decision-making process in the management of pJA and definition of postoperative surveillance. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2436-E2441, 2021.
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Affiliation(s)
- Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Bolzoni Villaret
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giacomo Bertazzoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Cremona, Cremona, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ivan Zorza
- Unit of Radiology, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Farina
- Unit of Radiology, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
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15
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Lao WP, Lagabon KJ, Arom GA, Walker PC, Lee SC. Combined endoscopic and transoral resection of a high-staged juvenile nasopharyngeal angiofibroma: A pictorial essay. Head Neck 2020; 43:719-724. [PMID: 33111428 DOI: 10.1002/hed.26516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 11/06/2022] Open
Abstract
Juvenile nasopharyngeal angiofibromas (JNAs) are highly vascular and benign tumors that can expand into the skull base. Delay of treatment can result in intracranial invasion, requiring extensive open approaches such as a facial translocation, maxillary swing, or an orbitozygomatic craniotomy. We describe a single-stage, combined endoscopic and transoral approach on a 14-year-old male with extensive high-stage dumbbell-shaped JNA involving the infratemporal fossa, orbit, buccal space, and intracranial extension into Meckel's cave. Successful resection of the tumor and good postoperative outcome was achieved. A transoral approach allowed for greater access to the infratemporal fossa, where endonasal resection was not possible, allowing for improved visualization, greater traction, and dissection. In select highly staged JNAs with significant lateral extension and intracranial involvement, successful and complete resection may be accomplished with this combined approach. Utilization of this approach avoids the morbidity of more invasive open approaches.
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Affiliation(s)
- Wilson P Lao
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | | | - Gabriel A Arom
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Paul C Walker
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Steve C Lee
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
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16
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Sakthivel P, Thakar A, Prashanth A, Angamuthu M, Sharma SC, Kumar R. Clinical Applications of 68Ga-PSMA PET/CT on Residual Disease Assessment of Juvenile Nasopharyngeal Angiofibroma (JNA). Nucl Med Mol Imaging 2019; 54:63-64. [PMID: 32206135 DOI: 10.1007/s13139-019-00628-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022] Open
Abstract
We present a case of a 16-year-old boy who underwent 68Ga-PSMA PET/CT for residual disease assessment of juvenile nasal angiofibroma. Positive uptake was noted in residual tumor on PET/CT imaging. However, there was no abnormal uptake in surrounding scar tissues as compared with contrast-enhanced magnetic resonance imaging. These findings were confirmed by biopsy from the scar tissue on posterior ethmoids. 68Ga-PSMA PET/CT may be a potentially valuable tool especially in distinguishing recurrences from surgical site reparative tissue and in planning and delivering stereotactic radiotherapy.
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Affiliation(s)
- Pirabu Sakthivel
- 1Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- 1Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Prashanth
- 2Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Meivel Angamuthu
- 2Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh Chandra Sharma
- 1Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- 2Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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