Nasopharyngeal fibroma

Rare tumour: represents 0.05 % of all head and neck tumors.


Most common presentation: nasal obstruction associated with severe epistaxis occurring in a young boy. The symptoms are unilateral at first, and can become bilateral later. In severe forms, there may be pain, facial swelling or orbital involvement. A hormonal component has been suspected. The tumor usually originates in the sphenopalatine foramen region, from the sphenopalatine artery.


Radkowski's classification:


IA

IB

-        involvement limited to the nasal cavity and the nasopharynx

-        idem + involvement of 1 or more sinuses

IIA


IIB


IIC

-        minimal involvement through the sphenopalatine foramen and into the medial wall of the pterygoalatine fossa

-        filling of the pterygopalatine fossa, pressure on the posterior wall of the maxillary sinus, orbital erosion, displacement of the branches of the internal maxillary artery

-        involvement of the temporal fossa, of the cheek and the pterygoid apophyses posteriorly

erosion 
of skull base

IIIA

IIIB



-        minimal intracranial involvement

-        massive involvement of the cranium and the cavernous sinus


Treatments:


-        by endoscopy: the benefits over the external approach are a decreased intraoperative blood loss, complication rate, risk of recurrence, and length of hospitalization. Preoperative embolization (24 to 48 hours before surgery) is recommended for these highly vascularized tumors.

-        external approach: lateral rhinotomy, "midface degloving," Caldwell-Luc technique, transpalatine approach, Le Fort 1 and other infratemporal approaches

-        radiotherapy for unresectable locations.

Anesthetic implications:

nasal obstruction, hemorrhagic surgery


References:

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Updated: June 2020