Transnasal Endoscopic Surgery for Juvenile Angiofibroma Involving the Pterygopalatine Fossa

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  • Kageyama Asami
    Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Kitamura Yoshiaki
    Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Koda Hirokazu
    Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Nakano Seiichi
    Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Kamimura Seiichiro
    Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Matsuda Kazunori
    Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Abe Koji
    Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School
  • Takeda Noriaki
    Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School

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  • 経鼻内視鏡手術にて摘出した翼口蓋窩に進展した若年性血管線維腫例

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Abstract

<p>Juvenile angiofibroma (JA) is an uncommon, locally invasive, highly vascular and benign tumor that occurs in adolescent males. Established external surgical procedures for resection of JA include lateral rhinotomy, midfacial degloving, and transpalatal or infratemporal approaches; however, transnasal endoscopic approaches are increasingly being used because of advances in surgical techniques and endoscopic instrumentation. We report the case of a 14-year-old male who presented with left nasal obstruction and repeated epistaxis. A smooth reddish and hemorrhagic tumor was found in the left posterior nasal cavity. Computed tomography and magnetic resonance imaging showed a markedly enhanced tumor of approximately 40 mm in diameter that had obstructed the left posterior nasal cavity and nasopharynx, with occupancy of the pterygopalatine fossa. The case was diagnosed as Radkowski stage IIB. Preoperative embolization was performed to reduce tumor vascularity and improve visualization for surgical removal. Transnasal endoscopic surgery was used to resect the tumor en bloc after clipping the left maxillary artery. Intraoperative bleeding was 80 mL. To prevent recurrence, careful attention must be paid to tumor invasion into the Vidian canal. The postoperative course of our patient was uneventful, and there has been no evidence of recurrence for over one and a half years since surgery.</p>

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