Assisted resection of lateral extension of juvenile nasopharyngeal angiofibroma using a sphenopalatine fossa dissector. Issue 7 (18th June 2018)

• Record Type: Journal Article
• Authors: Mishra, A
• Is Part Of: Journal of laryngology & otology. Volume 132:Issue 7(2018)
• Page Start: 657
• Page End: 660
• Publication Date: 2018-06-18
• Subjects: Sphenopalatine Foramen, -- Angiofibroma, -- Nasopharynx; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1017/S0022215118000798
• Languages: English
• ISSNs: 0022-2151

Abstract

Abstract: Background: Juvenile nasopharyngeal angiofibroma often attaches firmly to the adjoining bony region around the sphenopalatine foramina–sphenopalatine fossa–pterygomaxillary fissure. This can result in hourglass-shaped constriction and predispose to incomplete resection (residual disease) with a transpalatal approach. This paper describes attempts to address this 'inaccessible' area with a novel instrument, used since 2012. Methods: Measurements of the sphenopalatine foramen, nasal septum, posterior nasopharyngeal wall and hard palate were undertaken in 20 skulls and 10 computed tomography scans (lateral extension). A device was designed (in terms of angulation and length) following several trials with malleable wire. A search of patents was also undertaken. Recurrence rates were compared in cases of device use and non-use. Results: The novelty of the sphenopalatine fossa dissector was established and the device was patented. This device has significantly improved our 17.59 per cent recurrence rate of the past 4 decades; of 63 cases over 3 years, there were only 3 recurrences and 2 residual disease cases. Findings of our previous studies with or without the device are compared. Conclusion: Existing evidence supports the incorporation of this inexpensive instrument in the armamentarium for resecting lateral extension of juvenile nasopharyngeal angiofibroma during a transpalatal approach.