Nasopharyngeal Angiofibroma MCQs

The tumor is testosterone dependent and hence is more common in adolescent males. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 289

Angiofibroma is the most common benign tumour of nasopharynx seen in adolescent males. It’s a highly vascular tumour. CECT scan shows Holman Miller(= Antral) sign – It is the anterior bowing of posterior wall of the maxillary sinus. It is pathognomic of angiofibroma. Angiography is also done before surgery to identify the main blood supply source of tumour. Pre-op embolisation will reduce blood loss(Maxillary Artery). Debulking or biopsy of this tumour is never done as it is a highly vascular tumour. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 292

Radkowski staging of Angiofibroma Stage IA - limited to nasopharynx and nose IB - extension into one or more than one sinus IIA - minimal extension into pterygopalatine fossa IIB - full occupation of pterygopalatine fossa with or without erosion of orbital bones IIC - extending Infratemporal Fossa IIIA - erosion of skull base with minimal intracranial invasion IIIB - extensive intracranial invasion with or without cavernous sinus invasion Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 293

The main feeding vessels of Juvenile Nasopharyngeal angiofibroma are the terminal branches of Maxillary Artery( which is a branch of External Carotid Artery) This artery is subjected to pre-operative embolization to reduce the blood loss during surgery. Resection of tumour should not be delayed beyond 24–48 h of embolization to avoid revascularization from the contralateral side. In very large tumors or those with intracranial extension, bloody supply may come from branches of Internal Carotid Artery. But these are not embolized. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 292

Angiofibroma is a highly vascular tumor and its blood vessels lack elastic tissue and muscle fibres and hence cannot contract. So pre-operative debulking of tumor results in massive hemorrhage. 75% of angiofibromas show androgen receptors accounting for growth in males at adolescence. So pre operative estrogen or flutamide(androgen blocker) play a role in preventing blood loss during surgery. Pre-operative embolization cuts off the feeding vessels and reduces blood loss during surgery. Feeders from only the external carotid system can be embolized. Resection of tumour should not be delayed beyond 24–48 h of embolization to avoid revascularization from the contralateral side. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 291, 295

Rhinolalia clausa is hyponasality. This is due to nasal obstruction, nasal polyp, si nusitis, adenoid hypertrophy, angiofibroma. Rhinolalia aperta is hypernasality. This is due to cleft palate, palatal perforation, palatal palsy, palatal weakness( velopharyngeal insufficiency), submucous cleft palate, bifid uvula. Dysphonia Plica Ventricularis is the production of sound from false vocal cords. Mogiophonia is speech defect in public appearance only Hot Potato voice = Plummy Voice - Seen in Quinsy, paraphrayngeal abscess, retropharyngeal abscess, prevertebral abscess, supraglottic and base tongue cancer Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 366, 368, 311