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Juvenile angiofibroma: a new technique for postoperative treatment and rehabilitation
International Journal of Pediatric Otorhinolaryngology, 6 (1983) 297-300
297
Elsevier
Clinical N o t e
Juvenile angiofibroma: a new technique for postoperative treatment and rehabilitation M. Sella a, I. G a y 2 and R. Feinmesser 2., Departments of IMaxillofacial Rehabilitation and of 'OtolaryngoloD,, Hadassa Medical School, Ein Karem, Jerusalem (Israel) (Received August15th, 1983) (Accepted October 19th, 1983)
Key words: juvenile angiofibroma - polyvinylchloride (PVC) - transparent plate
Introduction Juvenile nasopharyngeal angiofibroma is an uncommon benign tumor found in the nasopharynx of the adolescent male. It appears usually at the prepubertal period, causing mainly epistaxis and nasal obstruction. This tumor originates in the periostal layer of the bone arising in the embryonal occipital plate [4]. The diagnostic means enabling accurate imaging of angiofibroma have improved tremendously in the last decade. The high resolute C.T. scan [2] together with angiography [5] make it possible to determine the exact extension, invasiveness and vascularity of this tumor. Several methods have been described by various authors for treatment of juvenile angiofibroma. The most frequently advocated methods of treatment are: surgery, irradiation, cryotherapy, electrocoagulation, hormonal therapy, and watchful waiting. Most experienced physicians in this field feel that surgery is a method of choice in the treatment of juvenile nasopharyngeal angiofibroma except when the tumor had extended intracranially. The type of surgical procedure selected depends upon the location, size, and extension of the tumor. Tumors confined to the nasopharynx as demonstrated by radiology, angiography and inspection can be removed most satisfactorily by a transpalatal approach [1,6]. The purpose of this article is to introduce a technique where the use of a polyvinyl chloride (PVC) transparent mold improves healing and diminishes the rate of complications. * To whom correspondence should be addressed. 0165-5876/83/$03.00 © 1983 Elsevier Science Publishers B.V.
298 Material and Methods
An impression of the palate and teeth is made out of an irreversible hydrocolloid material. A cast is molded. A plate of 0.6 mm thickness is made out of polyvinylchloride (PVC) [3] on an omnivac machine, which operates on vacuum. The plate creates an accurate fitting between the palate, teeth and itself. The plate is retentive on the teeth (Fig. 1). Through a midline incision on the palate two mucosal flaps are raised laterally. The hard palate is exposed and drilled out. The tumor, which is exposed, is excised after sufficient haemostasis [6]. The palatal mucosal flaps are sutured in the midline with one 4-0 plain suture. The suture line is covered with the impression prepared beforehand (Fig. 2). Three days postoperatively the impression is removed, rinsed, and returned to its place. Seven days postoperatively the wound is examined and the impression is removed if findings permit (Fig. 3).
Results
Eleven patients hospitalized in the department of otolaryngology in the years 1975-1983 and diagnosed as suffering from juvenile nasopharyngeal angiofibroma, underwent surgical excision of the tumor through a transpalatal incision with the
Fig. 1. The transparent polyvinylchloride(PVC) plate.
299
Fig. 2. Transparent palate in place immediately after operation.
300 application of the PVC plate (previously described) on the operation site. In all cases recovery time was short and 7 days postoperatively the impression was removed. N o h a e m a t o m a and no necrosis of flaps in the area of the suture line were noticed. N o t one of the patients suffered local infections.
Discussion One of the c o m m o n l y accepted surgical approaches to juvenile nasopharyngeal angiofibroma is through a midline palatal incision and partial removal of the hard palate. Excision of the tumor in this manner is usually followed by insertion of a pack made out of gauze saturated with antibacterial ointment to the operation site. The gauze is usually a cause of malodour and encourages infection. We described a method where a palate made out of PVC and fitted exactly on the teeth may be used thus avoiding the use of a pack. The plate enables early feeding and good speech immediately after operation. The plate shortens the time of operation since only one suture is needed to hold the mucosal flap in place. The plate prevents the accumulation of haemotoma, thus shortening recovery period, and since it is transparent, complications are immediately detected and can be treated accordingly.
References 1 Dibble, P.A. and King, H.C., Juvenile nasopharyngeal angiofibroma, Laryngoscope, 72 (1962) 218. 2 Levine, H.L., Weinstein, M.A., Tucker, H.A., Wood, B.G. and Duckesneau, P.M., Diagnosis of juvenile nasopharyngeal angiofibroma by computed tomography, Trans. Otolaryng., in press. 3 Lointz, J.F. and Schweiger, J.W., Maxillofacial restorative materials and techniques, Bull. Prosth. Res., 10-31 (1979) 119. 4 Ringertz, N. Pathology of malignant tumors arising in nasal and paranasal cavities and 5 Ward, P.H., Thompson, R., Calcaterra., T. and Kadin, M., Juvenile angiofibroma: a more rational therapeutic approach based upon clinical and experimental evidence, Laryngoscope, 84 (1974) 2181. 6 Wilson, C.P., The approach to the nasopharynx, Proc. roy. Soc. Med., 44 (1951) 353.
297
Elsevier
Clinical N o t e
Juvenile angiofibroma: a new technique for postoperative treatment and rehabilitation M. Sella a, I. G a y 2 and R. Feinmesser 2., Departments of IMaxillofacial Rehabilitation and of 'OtolaryngoloD,, Hadassa Medical School, Ein Karem, Jerusalem (Israel) (Received August15th, 1983) (Accepted October 19th, 1983)
Key words: juvenile angiofibroma - polyvinylchloride (PVC) - transparent plate
Introduction Juvenile nasopharyngeal angiofibroma is an uncommon benign tumor found in the nasopharynx of the adolescent male. It appears usually at the prepubertal period, causing mainly epistaxis and nasal obstruction. This tumor originates in the periostal layer of the bone arising in the embryonal occipital plate [4]. The diagnostic means enabling accurate imaging of angiofibroma have improved tremendously in the last decade. The high resolute C.T. scan [2] together with angiography [5] make it possible to determine the exact extension, invasiveness and vascularity of this tumor. Several methods have been described by various authors for treatment of juvenile angiofibroma. The most frequently advocated methods of treatment are: surgery, irradiation, cryotherapy, electrocoagulation, hormonal therapy, and watchful waiting. Most experienced physicians in this field feel that surgery is a method of choice in the treatment of juvenile nasopharyngeal angiofibroma except when the tumor had extended intracranially. The type of surgical procedure selected depends upon the location, size, and extension of the tumor. Tumors confined to the nasopharynx as demonstrated by radiology, angiography and inspection can be removed most satisfactorily by a transpalatal approach [1,6]. The purpose of this article is to introduce a technique where the use of a polyvinyl chloride (PVC) transparent mold improves healing and diminishes the rate of complications. * To whom correspondence should be addressed. 0165-5876/83/$03.00 © 1983 Elsevier Science Publishers B.V.
298 Material and Methods
An impression of the palate and teeth is made out of an irreversible hydrocolloid material. A cast is molded. A plate of 0.6 mm thickness is made out of polyvinylchloride (PVC) [3] on an omnivac machine, which operates on vacuum. The plate creates an accurate fitting between the palate, teeth and itself. The plate is retentive on the teeth (Fig. 1). Through a midline incision on the palate two mucosal flaps are raised laterally. The hard palate is exposed and drilled out. The tumor, which is exposed, is excised after sufficient haemostasis [6]. The palatal mucosal flaps are sutured in the midline with one 4-0 plain suture. The suture line is covered with the impression prepared beforehand (Fig. 2). Three days postoperatively the impression is removed, rinsed, and returned to its place. Seven days postoperatively the wound is examined and the impression is removed if findings permit (Fig. 3).
Results
Eleven patients hospitalized in the department of otolaryngology in the years 1975-1983 and diagnosed as suffering from juvenile nasopharyngeal angiofibroma, underwent surgical excision of the tumor through a transpalatal incision with the
Fig. 1. The transparent polyvinylchloride(PVC) plate.
299
Fig. 2. Transparent palate in place immediately after operation.
300 application of the PVC plate (previously described) on the operation site. In all cases recovery time was short and 7 days postoperatively the impression was removed. N o h a e m a t o m a and no necrosis of flaps in the area of the suture line were noticed. N o t one of the patients suffered local infections.
Discussion One of the c o m m o n l y accepted surgical approaches to juvenile nasopharyngeal angiofibroma is through a midline palatal incision and partial removal of the hard palate. Excision of the tumor in this manner is usually followed by insertion of a pack made out of gauze saturated with antibacterial ointment to the operation site. The gauze is usually a cause of malodour and encourages infection. We described a method where a palate made out of PVC and fitted exactly on the teeth may be used thus avoiding the use of a pack. The plate enables early feeding and good speech immediately after operation. The plate shortens the time of operation since only one suture is needed to hold the mucosal flap in place. The plate prevents the accumulation of haemotoma, thus shortening recovery period, and since it is transparent, complications are immediately detected and can be treated accordingly.
References 1 Dibble, P.A. and King, H.C., Juvenile nasopharyngeal angiofibroma, Laryngoscope, 72 (1962) 218. 2 Levine, H.L., Weinstein, M.A., Tucker, H.A., Wood, B.G. and Duckesneau, P.M., Diagnosis of juvenile nasopharyngeal angiofibroma by computed tomography, Trans. Otolaryng., in press. 3 Lointz, J.F. and Schweiger, J.W., Maxillofacial restorative materials and techniques, Bull. Prosth. Res., 10-31 (1979) 119. 4 Ringertz, N. Pathology of malignant tumors arising in nasal and paranasal cavities and 5 Ward, P.H., Thompson, R., Calcaterra., T. and Kadin, M., Juvenile angiofibroma: a more rational therapeutic approach based upon clinical and experimental evidence, Laryngoscope, 84 (1974) 2181. 6 Wilson, C.P., The approach to the nasopharynx, Proc. roy. Soc. Med., 44 (1951) 353.