Endoscopic Resection of Nasopharyngeal Angiofibroma: The Role of Radio-Frequency Coblation

Abstract

Nasopharyngeal angiofibromas are histologically benign but locally aggressive vascular tumors that can result in major morbidity and mortality. They exclusively affect adolescent male and are rare in patients older than 25 years. The management of nasopharyngeal angiofibroma is primarily surgical. Most small and medium sized tumors are resected endoscopically with a microdebrider. Our presentation demonstrates the role of radio-frequency coblation in the endoscopic management of angiofibroma that is confined to the nasal cavity, nasopharynx and paranasal sinuses. Through a brief video presentation, viewers will be able to appreciate the role of this instrument. We reviewed the case of an adult male patient who presented to our institute with nasopharyngeal angiofibroma. He underwent pre-operative embolization followed by endoscopic coblation of the tumor. A video demonstration is presented of a patient with nasopharyngeal angiofibroma who underwent successful transnasal endoscopic coblation. The coblator was used to resect the tumour attachment at the posterior end of the middle turbinate and the nasopharynx. The tumor was resected en-bloc and pushed into the oropharynx and eventually removed trans-orally. The natural ostium of the sphenoid sinus was enlarged and the residual tumor was removed. Absorbable nasal packing was inserted for haemostasis. Intra-operative bleeding was negligible. Radio-frequency coblation has a definite role in the endoscopic resection of small and medium sized nasopharyngeal angiofibroma. This technique is easy to learn and is extremely efficient. Tumors can be removed with minimal or no damage to surrounding tissues and intra-operative bleeding is negligible.