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Assisted resection of lateral extension of juvenile nasopharyngeal angiofibroma using a sphenopalatine fossa dissector

Published online by Cambridge University Press:  18 June 2018

A Mishra
A Mishra*
Affiliation:
Department of Otorhinolaryngology, King George's Medical University, Lucknow, India
*
Author for correspondence: Dr Anupam Mishra, A-1/19, sector H, Aliganj, Lucknow, Uttar Pradesh, India E-mail: [email protected]
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Abstract

Background

Juvenile nasopharyngeal angiofibroma often attaches firmly to the adjoining bony region around the sphenopalatine foramina–sphenopalatine fossa–pterygomaxillary fissure. This can result in hourglass-shaped constriction and predispose to incomplete resection (residual disease) with a transpalatal approach. This paper describes attempts to address this ‘inaccessible’ area with a novel instrument, used since 2012.

Methods

Measurements of the sphenopalatine foramen, nasal septum, posterior nasopharyngeal wall and hard palate were undertaken in 20 skulls and 10 computed tomography scans (lateral extension). A device was designed (in terms of angulation and length) following several trials with malleable wire. A search of patents was also undertaken. Recurrence rates were compared in cases of device use and non-use.

Results

The novelty of the sphenopalatine fossa dissector was established and the device was patented. This device has significantly improved our 17.59 per cent recurrence rate of the past 4 decades; of 63 cases over 3 years, there were only 3 recurrences and 2 residual disease cases. Findings of our previous studies with or without the device are compared.

Conclusion

Existing evidence supports the incorporation of this inexpensive instrument in the armamentarium for resecting lateral extension of juvenile nasopharyngeal angiofibroma during a transpalatal approach.

Keywords

Sphenopalatine ForamenAngiofibromaNasopharynx
Type
Short Communication
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 7 , July 2018 , pp. 657 - 660
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr A Mishra takes responsibility for the integrity of the content of the paper

References

1Mishra, A, Mishra, SC. Time trends in recurrence of juvenile nasopharyngeal angiofibroma: experience of the past 4 decades. Am J Otolaryngol 2016;37:265–71Google Scholar
2Chew, CT. Nasopharynx (the postnasal space). In: Kerr, AG, Groves, J, eds. Scott-Brown's Otolaryngology, Volume IV: Rhinology, 5th edn. London: Butterworth, 1987Google Scholar
3Mishra, A, Mishra, SC. Changing trends in the incidence of juvenile nasopharyngeal angiofibroma: seven decades of experience at King George's Medical University, Lucknow, India. J Laryngol Otol 2016;130:363–8Google Scholar
4Mishra, A, Mishra, SC, Verma, V, Singh, HP, Kumar, S, Tripathi, AM et al. In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma. J Laryngol Otol 2016;130:462–73Google Scholar