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Castelnuovo P, Lambertoni A, Sileo G, Valentini M, Karligkiotis A, Battaglia P, Turri-Zanoni M. Critical review of multidisciplinary approaches for managing sinonasal tumors with orbital involvement. ACTA ACUST UNITED AC 2021; 41:S76-S89. [PMID: 34060523 PMCID: PMC8172109 DOI: 10.14639/0392-100x-suppl.1-41-2021-08] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/04/2021] [Indexed: 02/03/2023]
Abstract
Orbital invasion is frequently observed in tumors involving the maxillary, ethmoid and frontal sinuses given the proximity of the orbit to the sinonasal tract and ventral skull base. The main objective of the present review is to determine the existing evidences on the frequency, treatment, and outcomes of orbital invasion in benign and malignant sinonasal tumors. A systematic review of the literature published from 1995 to 2020 was performed and data sources included PubMed, Cochrane library, NCBI Bookshelf, National Guideline Clearinghouse. Orbital invasion was reported in 2-4% of inverted papillomas, 12-15% of fibro-osseous lesions, 27-32% of juvenile angiofibromas, 35-45% of low-grade malignancies, and 50-80% of high-grade cancers. Surgical resection with negative margins represents the cornerstone of management for benign and low-grade malignant tumors. Histology-specific induction chemotherapy can be used for high-grade sinonasal cancers in order to downstage the tumor and increase the possibility of orbital preservation. When a significant response to induction chemotherapy is observed, exclusive chemoradiation should be offered to improve overall survival rates. Appropriate reconstruction of any surgical defects is essential in order to minimize complications and optimize functional and aesthetic outcomes. Orbital apex invasion represents a negative prognostic factor. In conclusion, a multidisciplinary teamwork is mandatory to maximize local control, minimize morbidity and improve orbital preservation rates.
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Affiliation(s)
- Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alessia Lambertoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giorgio Sileo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marco Valentini
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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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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3
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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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Abstract
ABSTRACT Surgical removal of pterygopalatine fossa (PPF) tumors with endoscopic endonasal approach is still challenging. The present study aimed to evaluate our endoscopic endonasal management of PPF tumors based on the tumor pathology and purpose of the surgery. This comprised both a single nostril approach for biopsy and a binostril approach for complete resection of benign and noninfiltrating tumors. Based on this strategy, 12 patients underwent endoscopic endonasal surgery for PPF tumors between 2013 and 2018. The patients' data were analyzed retrospectively to demonstrate the significance of our treatment scheme. The surgery was terminated only after taking a biopsy specimen in 6 patients. Other 6 patients underwent gross total resection or bulk tumor reduction. Final pathological diagnosis was malignant in 6 cases and benign in the remaining 6. Post-operative treatment was needed in 7 patients. Four operations for the 6 patients who underwent either debulking or radical surgery were performed by the binostril approach; while 5 surgeries for the 6 biopsy patients were performed by the single nostril approach. Postoperative complications were tolerable. Endoscopic resection should be adopted preferentially for benign tumors that can be removed in a piecemeal fashion. However, as most malignant tumors were impossible to resect with a negative margin, priority should be given to tumor biopsy using an endoscopic approach, which is less invasive than an open approach, and an appropriate treatment customized to the pathological diagnosis should be administered.
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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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Gargula S, Saint-Maurice JP, Labeyrie MA, Eliezer M, Jourdaine C, Kania R, Wassef M, Adle-Biassette H, Houdart E, Herman P, Verillaud B. Embolization of Internal Carotid Artery Branches in Juvenile Nasopharyngeal Angiofibroma. Laryngoscope 2020; 131:E775-E780. [PMID: 33001464 DOI: 10.1002/lary.29119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/15/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Preoperative embolization of juvenile nasopharyngeal angiofibroma (JNA) is usually performed by the occlusion of branches of the external carotid artery (ECA). However, a significant proportion of JNAs also receive blood from the internal carotid artery (ICA). The objective of this study was to report on the feasibility and clinical impact of superselective embolization of ICA branches in complex cases of JNA. METHODS This was a single-center retrospective study of all patients operated on for JNA between 2000 and 2018. The patients treated with embolization of branches of the ICA were identified. The results in terms of complications, intraoperative blood loss, and rate of residual disease were analyzed and compared to those of a control group of patients treated only with embolization of ECA branches and matched by age, stage, angiographic pattern, surgical approach, and previous surgery. RESULTS Ninety-two patients were included. Embolization of branches of the ICA was attempted in 14 cases of advanced or recurrent tumors and was ultimately possible in nine cases. There were no complications after embolization. The mean intraoperative blood loss was 1428 mL. Residual disease was found in three cases (33%). There was no significant difference compared with the control group (mean intraoperative blood loss = 1355 mL, residual disease = 4 (44%); all P > .05). CONCLUSION In this retrospective study, we report the feasibility of superselective embolization of ICA branches in selected cases of JNA. There was no observed benefit of this technique in terms of intraoperative bleeding or decreased risk of residual disease. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E775-E780, 2021.
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Affiliation(s)
- Stéphane Gargula
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jean-Pierre Saint-Maurice
- Department of Neuroradiology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marc-Antoine Labeyrie
- Department of Neuroradiology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Michael Eliezer
- Department of Neuroradiology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - Clément Jourdaine
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Romain Kania
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, INSERM U1141, Université de Paris, Paris, France
| | - Michel Wassef
- Department of Pathology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - Homa Adle-Biassette
- Department of Pathology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - Philippe Herman
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, INSERM U1141, Université de Paris, Paris, France
| | - Benjamin Verillaud
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, INSERM U1141, Université de Paris, Paris, France
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Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
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8
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Llorente JL, López F. The endoscopic endonasal approach for the treatment of juvenile angiofibromas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 70:136-144. [PMID: 29764608 DOI: 10.1016/j.otorri.2018.01.004] [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: 12/31/2017] [Accepted: 01/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Juvenile angiofibroma (JA) is a benign tumour, for which the treatment of choice is surgery. It may be associated with significant morbidity because of its anatomical location and its locally destructive growth pattern. Severe haemorrhage constitutes a high risk in JA and its surgical management can be complex. The management of JA remains a challenge. The objective of this study was to review a series of patients with JA treated via the endonasal/endoscopic approach. MATERIAL AND METHODS Medical records of patients operated for JA were reviewed. MAIN OUTCOME MEASURES tumour stage, intraoperative blood loss, complications and persistence/recurrence rates. RESULTS A total of 30 male patients and one female were included. The mean age was 17 years. Using the Radkowski classification, one JA was classified as stage I, 5 stage IIA, 9 stage IIB, 4 stage IIC, 10 stage IIIA and 2 stage IIIB. Thirty-nine percent of the JA was classified as advanced stage JA (IIIA and IIIB). The mean blood loss was 1.156mL Except in one case, no significant complications were observed. Tumour persistence/recurrence was observed in 2 JA (6%), at the end of the follow-up. Mean postoperative follow-up time was 86 months. CONCLUSIONS This retrospective study supports the notion that endonasal endoscopic approaches for a JA are a feasible option associated with good long-term results.
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Affiliation(s)
- José Luis Llorente
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España.
| | - Fernando López
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
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9
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The Endoscopic Endonasal Approach for the Treatment of Juvenile Angiofibromas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schreiber A, Bertazzoni G, Ferrari M, Ravanelli M, Rampinelli V, Mattavelli D, El‐Naggar A, Nicolai P. Management of persistent juvenile angiofibroma after endoscopic resection: Analysis of a single institution series of 74 patients. Head Neck 2018; 41:1297-1303. [DOI: 10.1002/hed.25555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/12/2018] [Accepted: 11/09/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Alberto Schreiber
- Unit of Otorhinolaryngology – Head and Neck SurgeryUniversity of Brescia Brescia Italy
| | - Giacomo Bertazzoni
- Unit of Otorhinolaryngology – Head and Neck SurgeryUniversity of Brescia Brescia Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology – Head and Neck SurgeryUniversity of Brescia Brescia Italy
| | | | - Vittorio Rampinelli
- Unit of Otorhinolaryngology – Head and Neck SurgeryUniversity of Brescia Brescia Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck SurgeryUniversity of Brescia Brescia Italy
| | - Ahmed El‐Naggar
- Unit of Otorhinolaryngology – Head and Neck SurgeryUniversity of Brescia Brescia Italy
- Unit of OtorhinolaryngologyTanta University Tanta Egypt
| | - Piero Nicolai
- Unit of Otorhinolaryngology – Head and Neck SurgeryUniversity of Brescia Brescia Italy
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Mattavelli D, Rampinelli V, Ferrari M, Schreiber A, Guarneri B, Nicolai P. Long-term neurological morbidity following endoscopic transnasal resection of juvenile angiofibroma. Laryngoscope 2018; 129:2184-2188. [PMID: 30315581 DOI: 10.1002/lary.27466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although transnasal endoscopic resection (TER) of juvenile angiofibroma (JA) is unquestionably less invasive than traditional external approaches, several endonasal and neurovascular structures are sacrificed during the procedure. The aim of this study was to evaluate long-term neurological morbidity and related quality of life following TER of JA. STUDY DESIGN Retrospective cohort study. METHODS All patients who underwent TER for JA at the Unit of Otorhinolaryngology-Head and Neck Surgery of the University of Brescia from 1994 to 2016 were contacted to know their availability to undergo a battery of tests aimed to assess lacrimal secretion (Schirmer test), impairment of sensitive nerves (electrophysiological threshold test), and impact on quality of life of tearing reduction and sensitivity impairment with the Ocular Surface Disease Index (OSDI) and visual analogue scale (VAS) (0-10), respectively. RESULTS Thirteen patients were included. Mean follow-up was 77 months (range, 19-156 months). The median Schirmer test value was 5.5 mm and 28.5 mm for the treated and untreated sides, respectively (P = .003). Analysis of sensitivity revealed significant impairment only in the hard palate. The mean OSDI score was 6.8 (normal). The mean values of the VAS scores for hard palate, buccal mucosa, gum, and premaxillary skin were 1.7, 1.7, 1.2, and 2.3, respectively. CONCLUSIONS TER for JA can result in objective reduction of lacrimal secretion and sensitivity impairment; nevertheless, their impact on quality of life is negligible. The predictable neurological morbidity of TER should be discussed during preoperative counseling. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2184-2188, 2019.
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Affiliation(s)
| | | | | | | | - Bruno Guarneri
- Unit of Electrophysiology, University of Brescia, Brescia, Italy
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López F, Triantafyllou A, Snyderman CH, Hunt JL, Suárez C, Lund VJ, Strojan P, Saba NF, Nixon IJ, Devaney KO, Alobid I, Bernal-Sprekelsen M, Hanna EY, Rinaldo A, Ferlito A. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head Neck 2017; 39:1033-1045. [PMID: 28199045 DOI: 10.1002/hed.24696] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/03/2016] [Accepted: 12/06/2016] [Indexed: 12/12/2022] Open
Abstract
Juvenile angiofibroma is an uncommon, benign, locally aggressive vascular tumor. It is found almost exclusively in young men. Common presenting symptoms include nasal obstruction and epistaxis. More advanced tumors may present with facial swelling and visual or neurological disturbances. The evaluation of patients with juvenile angiofibroma relies on diagnostic imaging. Preoperative biopsy is not recommended. The mainstay of treatment is resection combined with preoperative embolization. Endoscopic surgery is the approach of choice in early stages, whereas, in advanced stages, open or endoscopic approaches are feasible in expert hands. Postoperative radiotherapy (RT) or stereotactic radiosurgery seem valuable in long-term control of juvenile angiofibroma, particularly those that extend to anatomically critical areas unsuitable for complete resection. Chemotherapy and hormone therapy are ineffective. The purpose of the present review was to update current aspects of knowledge related to this rare and challenging disease. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1033-1045, 2017.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, Spain
| | - Asterios Triantafyllou
- Pathology Department, Liverpool Clinical Laboratories, Liverpool, UK.,School of Dentistry, University of Liverpool, Liverpool, UK
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Carlos Suárez
- Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, Spain
| | - Valerie J Lund
- Professorial Unit, Ear Institute, University College London, London, UK
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Iain J Nixon
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK
| | | | - Isam Alobid
- Department of Otolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Department of Otolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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Benign Primary Neoplasms. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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