Endoscopic surgery for adolescent nasopharyngeal fibrovascular tumors

Nasopharyngeal angiofibroma is a benign tumor that occurs in young men. The tumor is rich in blood vessels, originated in the cranial suture of the skull base, deep in the area, local expansion, easy residual and recurrence of surgery, and massive bleeding can be life-threatening. Surgical resection is the most common and effective treatment. The main surgical approach is transforaminal and nasal incision. In 1996, Kemal introduced an endoscopic surgical approach. Radiotherapy, hormone therapy, cryotherapy, electrocoagulation, sclerotherapy and chemotherapy have a certain success rate. Selective arterial embolization greatly reduces intraoperative bleeding and improves the cure rate. Endoscopic nasopharyngeal angiofibroma surgery advantages: 1 to avoid facial, ankle or lip incision; 2 surgical trauma; 3 endoscopic examination of the presence or absence of tumor residual vision is clearer and more precise. Treatment of diseases: nasopharyngeal angiofibroma Indication Endoscopic nasopharyngeal angiofibroma surgery is only suitable for small tumors, and the lesions are limited to the nasal cavity, nasopharynx and sphenoid sinus. Preoperative preparation 1. The surgeon should have experience in endoscopic surgery. Surgical complications should be adequately prepared before surgery, such as major bleeding. If the tumor cannot be removed under endoscopy, there should be preparation to change the surgical approach at any time. 2. CT scan to observe the extent of tumor invasion. 3. Preoperative angiography, observing the blood supply artery of the tumor, and embolizing the blood vessel, can safely and thoroughly remove the tumor. Surgical procedure 1. Excision of the posterior portion of the middle turbinate can fully expose the roots of smaller tumors. 2. Remove the uncinate process. If the middle turbinate is gasified, the lateral part of the middle turbinate should be removed. 3. Look for the middle nasal passage of the maxillary sinus and expand it fully: expand up to the base of the sac, expand down to the inferior turbinate, back to the posterior wall of the maxillary sinus, and expand slightly forward, taking care not to damage the nasolacrimal duct. After the inner wall of the maxillary sinus is removed, the posterior wall of the maxillary sinus can be clearly observed. 4. Cut the mucosa several millimeters from the inside of the tumor to attract the tumor roots. The mucosa is separated from the tumor pedicle by a suction stripper. The tumor was cut from the periosteum of the pterygopalatine with a bipolar coagulator, and the tumor was removed and the tumor was removed with a snare, and the tumor root was electrocauterized. 5. If the tumor protrudes into the pterygopalatine fossa, the long stalk and large diamond drill bit can be used to carefully remove the posterior wall of the maxillary sinus from the inside to the outside, reveal the periosteum of the pterygopalatine fossa, and expand the part of the tumor to the outside to fully reveal the root of the tumor. In addition to the pterygopalatine front, a suction diathermy is used to electrocauterize the mucosa several millimeters above, after, inside, and below the tumor attachment. 6. Properly stop bleeding, observe whether the tumor is completely removed under endoscopy. The expansion cavity is filled with an expanded sponge or iodoform gauze. 7. If the nasopharynx mass is too large, the soft sputum can be incision to remove the nasopharynx mass, and the nasal cavity mass is removed by endoscopy.