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
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