Juvenile angiofibroma is a rare, basically invasive, practically mild, vascular neoplasm. Due to its being developed in inaccessible spot in the nasopharynx, open surgery generally needs osteotomies that lead to diminishing of facial growth in adolescent boys. It is seen exclusively in adolescent males prominently.
Features of Juvenile Angiofibroma
- Distinguishing features encompasses the site of origin, process of spread and systems of arterial supply.
- Though mild, its assertive nature is visible as it disseminates along natural tissue planes and foramina.
- It begins in the upper lining of the sphenopalatine foramen, created by the branching of palatine bone, horizontal ala of vomer and base of pterygoid process.
- It grows ahead into the nasal region, upwards into the sphenoid, and spreads into the pterygopalatine fossa, via pterygomaxillary fissure into the infratemporal fossa.
Causes of Juvenile Angiofibroma
Juvenile angiofibroma is not a common disorder. It is basically seen in adolescent boys. The tumor in question, have several blood arteries, spreading within the region in which it begins, and can lead to bone damage.
Symptoms of Juvenile Angiofibroma
- Problem in respiration via nose
- Frequent and easy bruising
- Frequent or recurrence of nose bleeding
- Loss of hearing capacity
- Nasal discharge, often bloody
- Prolonged bleeding
- Stuffy nose
Exams and Tests
The doctor may detect the angiofibroma when checking the upper throat.
Tests may include:
- Arteriogram to judge the blood supply to the growth
- MRI scan of the head
- CT scan of the head
Biopsy is usually not suggested due to the high risk of blood loss.
The primary forms of modalities are radiotherapy and surgery.
- Combination therapy has been used for severe tumors which are either surgically cannot be removed or have intracranial extension.
- Previously, treatments are recommended of expectant management, surgery, irradiation, embolization and hormonal therapy. With the discovery of exact staging of disease, the selection of primary treatment modality has been increased many folds.
- Minimally reactive therapy in terms of endoscopic resection is now available for small, extracranial tumours.
Radiotherapy is now mostly recommended for the life threatening ailment. Its side effects may encompass stunted craniofacial development and expected carcinogenicity therefore it is not suggested to go for radiotherapy for adolescent males.
Choice of the surgical option is recommended by several factors like location of tumor, expansion, tumor vasculature and influence of embolisation, surgical proficiency available and craniofacial age of the patient. Almost 40% of vertical maxillary development is witnessed after 12 years of age. Hence, craniofacial surgery in pubertal males potentially leads to facial growth disorder.
- The surgical approaches can be endoscopic transnasal, medial maxillectomy, LeFort 1 osteotomy, transpalatal, and infratemporal with or in the absence of craniotomy.
- Tumor restricted to the nasal cavity and paranasal sinuses can be handled by endoscopic or transpalatal options.
- More severe pterygopalatine engagement requires the exposure to the LeFort 1 or medial maxillectomy approach.
Endoscopic Trans-nasal Approach
- This is the only option that creates minimal soft tissue and bony disorder, hence, it offers better cosmesis and without any craniofacial growth disorder.
- It is considered as excellent endoscopic visualization of the paranasal sinuses, vis-à-vis other approaches.
- It counters the requirements for pre-operative embolisation as it enables transantral monitoring of internal maxillary veins. Hence, it is the best approach to opt for in this case.
- However, due to restricted accessibility, it is advisable only for small, extracranial tumours limited to the nasopharynx, nasal cavity and sphenoid sinus.
- Treatment is obvious if the angiofibroma is developing faster, bigger hindering the air passages, or causing frequent nosebleeds. In some cases, there is no need of any kind of treatment.
- Surgery may be required to resect the tumor. Removal is generally tough as the tumor is not limited and may have spread to other parts.
- A procedure called embolization may be selected to ward off bleeding of the tumor. The process may fix the nosebleeding by itself, or a further surgery to remove the tumor can also be required.
The objective of treating the juvenile angiofibroma is to accomplish symptomatic monitoring, if not, total eradication of the ailment. This will be based on right assessment of the stage of the disease extent, right choice of treatment modality and monitoring for disease recurrence.
For small, extracranial tumors, restricted to the nasal cavity and paranasal sinus, endoscopic resection is one of the best substitutes.
Albeit not cancerous, angiofibroma may keep on growing. Some may vanish untreated.
It is often witnessed that the tumor returns after surgery.
- Pressure on the brain (rare)
- Dissemination of the tumor to the sinuses, nose, sinuses, and other parts off shooting from nose
When to Call a Medical Practitioner
Call your health care professional if your nose often bleeds.
There are no known preventive measures available to resort.