Coblation Assisted Endoscopic Excision of Juvenile Nasopharyngeal Angiofibroma- An Institutional Observational Study

Dr Khageswar Rout,Dr Pradipt Ranjan Sahoo,Dr Kumari Jyoti Mani

doi:10.17511/jooo.2019.i08.06

Dr Khageswar Rout, Dr Pradipt Ranjan Sahoo + Show 1 more

Open Access

https://doi.org/10.17511/jooo.2019.i08.06

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Abstract

Objective: The purpose of our case series is to highlight the role of coblation in endoscopic JNA excision in terms of blood loss, duration of surgery and hospital stay. This was a Retrospective study done at Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha between January 2014 to June 2019 which includes 12 patients of JNA. Material and Method: The present case series was of 12 cases of JNA removal by endoscopic approach using coblation. Proper history taking and clinical examination was done in all cases. All patients were male between age group 5 to 20 years in the present series. In all patients preoperative CECT and MRI was done and staged according to Radkowski staging system. Out of 12 patients, 9 patients (Radkowski stage IB, IIA & IIB) were operated without embolization & 3 patients (Radkowski stage IIB & IIIA) were embolized 24 hr before operation. Result: The present study suggests that coblation decreases the chances of intraoperative bleeding, provides clear surgical field thus reduces operative time. Coblation helps in debulking of tumor, preserving anatomical integrity, increases chance of complete removal and reduces the recurrence. Coblation decreases use of frequent and multiple instrumentation. So use of coblation in JNA removal (with or without preoperative embolization) gives advantage of safe and effective results. Conclusion: Hence, none of the 12 patients required post-operative blood transfusion and follow-up showed no complications in any of the cases.

Highlights

Juvenile Nasopharyngeal Angiofibroma is a benign, locally aggressive, highly vascular tumor accounts for 0.05%-0.5% of all head and neck neoplasms primarily affecting adolescent males, the average age of presentation being around 14 to 18 years [1,2,3,4]
The term juvenile nasopharyngeal angiofibroma was given by Chaveau in 1906 due to its early submucosal extension towards the nasopharynx, as it occurs mostly in juvenile age group and histologically consist of vascular and fibrous components [1,5].Various etiologic mechanism including vascular, hormonal and genetic factors are responsible for development of JNA
All patients were male between age group 5 to 20 years

Summary

Introduction

Juvenile Nasopharyngeal Angiofibroma is a benign, locally aggressive, highly vascular tumor accounts for 0.05%-0.5% of all head and neck neoplasms primarily affecting adolescent males, the average age of presentation being around 14 to 18 years [1,2,3,4]. It was first described in 1847 by Chelius who stated that fibrous nasal polyp commonly occurs in persons around the time of puberty [5]. The high level of androgen receptor expression, vascular endothelial growth factor and transforming growth factor indicates initiation and growth of the lesion [6].

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