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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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Juvenile 'Perinasal' Angiofibroma.

Anupam Mishra1, Veerendra Verma1, Subhash Chandra Mishra1,2,3

  • 1Department of Otorhinolaryngology, King George Medical University (KGMU), A-1/19, Sector H, Aliganj, Lucknow, India.

Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India
|February 28, 2017
PubMed
Summary

Juvenile perinasal angiofibroma (JPA) is a distinct entity presenting as facial swelling. Early suspicion and biopsy are crucial for accurate diagnosis and staging of this JNA variant.

Keywords:
AngiofibromaExtranasopharyngealInfratemporal fossa

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Area of Science:

  • Head and Neck Surgery
  • Otolaryngology
  • Pathology

Background:

  • Extranasopharyngeal angiofibromas involving the infratemporal fossa and cheek are distinct from juvenile nasopharyngeal angiofibroma (JNA).
  • These tumors have been termed juvenile perinasal angiofibroma (JPA) in this study.
  • JPA is considered a variant of JNA that does not extend medially.

Purpose of the Study:

  • To present the seventh reported case of JPA.
  • To review the existing world literature on JPA.
  • To propose a staging system for JPA.

Main Methods:

  • Case presentation of a 16-year-old male with a painless facial swelling.
  • Diagnostic imaging to evaluate the lesion.
  • Deep trucut biopsy for histopathological confirmation.
  • Surgical excision via an open approach (Weber Fergusson technique).

Main Results:

  • The patient presented with a 7-month history of facial swelling without epistaxis or nasal obstruction.
  • Imaging suggested JNA without nasal extension.
  • Histopathology confirmed JPA.
  • The tumor showed significant vascular enhancement and was successfully excised.
  • JPA typically presents in Stage II.

Conclusions:

  • JPA is a variant of JNA, characterized by its location and lack of medial extension.
  • Imaging may show classical JNA findings with a clear nasal/nasopharyngeal pathway.
  • Deep trucut biopsy can be a valuable diagnostic tool.
  • Stage II JPA often requires an open facial approach, potentially preceded by embolization.
  • High clinical suspicion is necessary to avoid misdiagnosis of JPA presenting as facial swelling.