“Endoscopic Management of Advanced Juvenile Nasopharyngeal Angiofibroma with Extensive Infratemporal Fossa Extension: Surgical Challenges and Technical Modifications”- Case report
This case report demonstrates that exclusive endoscopic transnasal excision, combined with preoperative embolisation, can successfully achieve complete resection of an advanced juvenile nasopharyngeal angiofibroma with extensive infratemporal fossa extension while avoiding the morbidity associated with open surgical approaches.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the hidden corridors of the human head, where the nose meets the brain and the eye socket, a rare and tricky problem can arise in teenage boys. It involves a specific type of growth called a juvenile nasopharyngeal angiofibroma. Despite its complex name, it is a benign, or non-cancerous, tumor that behaves like a sponge filled with blood vessels. It starts near the back of the nose and has a tendency to push outward, invading nearby spaces like the cheek, the eye socket, and even the deep areas behind the face known as the infratemporal fossa. Because these tumors are so rich in blood, removing them has traditionally been a high-stakes operation. Surgeons often had to make large cuts across the face or under the jaw to reach the tumor, a process that could leave significant scars and carry risks of heavy bleeding. The medical community has long sought a way to remove these difficult masses using only the natural opening of the nose, but the deep and wide reach required for advanced cases has made this approach seem impossible for many.
A team of surgeons at the All India Institute of Medical Sciences in Bhopal, India, recently shared a story of how they successfully navigated this challenge in an eleven-year-old boy. The child had been suffering for a year with a bulging left eye and, more recently, a swelling on his left cheek. When doctors looked inside his nose, they found a mass of blood vessels that had grown from the back of the nasal cavity into the deep spaces of the face, the eye socket, and even up toward the brain. Scans showed the tumor was roughly the size of a small grape, measuring about 5.1 by 5.5 by 5.7 centimeters, and it was being fed by branches of a major artery. To make the surgery safer, the medical team first used a catheter to block off the blood vessels feeding the tumor, a step that significantly reduced the risk of bleeding during the operation.
The surgeons then decided to attempt a removal using only an endoscope, a thin tube with a camera, inserted through the nose. This approach avoids the large external cuts of traditional surgery, but reaching a tumor that had spread so far to the side and back of the face is extremely difficult with a straight instrument. The tumor was pressing against critical structures, including the internal carotid artery, a major vessel that supplies blood to the brain. The surgeons found that while the tumor was right next to this artery, it had not grown into it, which meant it could be separated safely. To gain the necessary angle to reach the far side of the tumor, the team made one very small, strategic modification to their standard technique. They made a tiny incision in the natural crease where the side of the nose meets the cheek, known as the alar groove. This small opening allowed them to maneuver their tools with a wider range of motion, reaching the deep, lateral parts of the tumor that would have been impossible to access from the nose alone.
Using this combined approach, the surgeons were able to carefully peel the tumor away from the surrounding tissues and remove it entirely. The boy recovered without any new problems, and his vision and eye movements remained normal. Two months later, follow-up scans showed no sign that the tumor had returned, and the tiny scar from the incision had healed so well it was barely visible. The pathologist confirmed that the removed tissue was indeed the rare angiofibroma. This case demonstrates that even when a tumor has spread extensively into the deep spaces of the skull, it is possible to remove it completely using a minimally invasive method that relies mostly on the nose, with only a very small, hidden external aid. The success suggests that with careful planning and slight adjustments to the surgical path, the need for more invasive, scarring operations can be avoided for patients with these complex conditions.
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