Juvenile Nasopharyngeal Angiofibroma
Overview
Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascular neoplasm of the nasal cavity and nasopharynx that classically presents in adolescent boys.
Pathophysiology
Relevant Anatomy
Disease Etiology
Genetics
Histology
Diagnosis
Patient History
Physical Examination
Laboratory Tests
Imaging
[Text about imaging choices]
There are several classification systems that have been proposed for JNAs based on imaging findings.
| Classification System | Stage I | Stage II | Stage III | Stage IV | Stage V |
|---|---|---|---|---|---|
| Andrews (1989)[1] | Confined to NP | Invading one of the following with evidence of bony erosion: PPF, MS, ES, or SS | Invading ITF or orbit IIIa: No intracranial extension IIIb: Extradural (parasellar) extension |
Intradural extension IVa: No infiltration of CS, PF, or OC IVb: Infiltration of CS, PF, or OC |
-- |
| Chandler (1984)[2] | Confined to NP | Extension into the nasal cavity, SS, or both | Extension into any of the following: antrum, ES, PMF, ITF, orbit, or cheek | Intracranial extension | -- |
| Onerci (2006)[3] | Nose, NP, ES, and SS or minimal extension into PMF | MS involvement, full occupation of PMF, extension to anterior cranial fossa, limited extension into ITF | Deep extension into cancellous bone at pterygoid base or body and GW of sphenoid, significant lateral extension into ITF or pterygoid plates, orbital involvement, CS obliteration | Intracranial extension between pituitary gland and ICA, tumor localization lateral to ICA, middle fossa extension and extensive intracranial extension | -- |
| Radkowski (1996)[4] | IA: Confined to nose or NP IB: extends into one or more sinuses |
IIa: minimal extension into medial PMF IIb: full occupation of PMF with local mass effect IIc: extension into ITF, cheek, or posterior to pterygoid plates |
Erosion of skull base: IIIa: minimal skull base involvement IIIb: extensive intracranial extension, with or without invasion into CS |
-- | -- |
| UPMC (2010)[5] | Nasal cavity, medial PPF | Paranasal sinuses, lateral PPF; no residual vascularity | Skull base erosion, orbit, ITF involvement; no residual vascularity | Skull base erosion, orbit, ITF involvement; residual vascularity | Intracranial extension with residual vascularity M: medial extension L: lateral extension |
Differential Diagnosis
Management
Medical Management
Surgical Management
Outcomes
Complications
Prognosis
References
- ↑ Andrews JC, Fisch U, Aeppli U, Valavanis A, Makek MS. The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach. The Laryngoscope. 1989 Apr;99(4):429-37.
- ↑ Chandler JR, Moskowitz L, Goulding R, Quencer RM. Nasopharyngeal angiofibromas: staging and management. Annals of Otology, Rhinology & Laryngology. 1984 Jul;93(4):322-9.
- ↑ Onerci M, Oğretmenoğlu O, Yücel T. Juvenile nasopharyngeal angiofibroma: a revised staging system. Rhinology. 2006 Mar 1;44(1):39-45.
- ↑ Radkowski D, McGill T, Healy GB, Ohlms L, Jones DT. Angiofibroma: changes in staging and treatment. Archives of Otolaryngology–Head & Neck Surgery. 1996 Feb 1;122(2):122-9.
- ↑ Snyderman CH, Pant H, Carrau RL, Gardner P. A new endoscopic staging system for angiofibromas. Archives of Otolaryngology–Head & Neck Surgery. 2010 Jun 21;136(6):588-94.