Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasopharynx, which is characteristic mainly for boys and young men. Structurally, it is composed of the fibrous tissue and thin-walled vessels, which are bleeding from time to time. The tumor is characterized by an aggressive course. Depending on the growth direction, over time it grows into the nasal cavity, paranasal sinuses and skull base, creating a threat to the patient’s life. The major treatment option is surgery. In some cases, the radiation techniques may be used.
The choice of the surgical technique depends on the formation size:
- For small tumors, surgery can be performed endoscopically through the natural orifices (mouth or nose). Such an intervention can minimize the tissue trauma.
- Another option of removing small JNA is through the palate. The surgeon makes a horseshoe-shaped incision on the upper edge of the gums, excises a portion of the palate on the affected side, and then resects the tumor. Such an access provides a broad overview of the nasopharynx.
- Medial tumors, which invaded the nasal cavity or orbit, are removed through the maxillary sinus. The incision in this case is made under the upper lip.
- Large JNA, invading the base of the skull, are dissected through the infratemporal fossa.
The day before surgery, the angiography is performed, which allows the embolization (occlusion) of blood vessels feeding the tumor and reduces the risk of bleeding.
JNA is removed to the fullest extent possible. If the total resection is not possible, the formation is excised partially, and the patient is prescribed radiation therapy after surgery. The following techniques are well-proven for angiofibromas:
- Stereotactic surgery (Gamma Knife). The tumor residue is affected by a high dose of radiation, which leads to the tumor cell death. The flows of radiation particles are formed so that most of the energy was targeted at the pathological focus. Thus, the healthy tissue is almost not subjected to irradiation. The procedure is performed only once. The effect is manifested over the next 6 to 24 months.
- Conformal radiotherapy. The tumor is irradiated precisely from different angles. Consequently, the major impact is targeted exactly at the pathological focus. The surrounding tissues are damaged to a lesser extent than upon conventional irradiation techniques. The sessions are repeated daily for several weeks.
For inoperable JNA, the radiation techniques may be indicated as the main treatment option.