Surgical treatment of nasopharyngeal fibrovascular tumor

Nasopharyngeal angiofibroma, also known as nasopharyngeal fibroma, includes male adolescent hemorrhagic fibroma or nasopharyngeal angiofibroma. The cause of this disease is unknown, and it is common in men between the ages of 10 and 25, and women are rare. Although the disease is benign in pathology, due to its strong growth and expansion, it often directly invades surrounding tissues and organs (such as nasal cavity, sinuses, pterygopalatine fossa, infraorbital fossa, eyelids), and even oppresses and destroys skull base invasion. Intracranial, causing a series of symptoms. Repeated massive bleeding can cause severe anemia, often endangering the patient's life, so the clinical table is actually an insult. Treatment of diseases: nasopharyngeal angiofibroma Indication Surgery is the preferred method for the treatment of nasopharyngeal angiofibroma. Contraindications 1, there is skull base bone destruction or paranasal infiltration, cranial nerve damage or distant metastasis. 2, there are liver and kidney dysfunction, poor overall condition. Preoperative preparation 1. It is not suitable for biopsy because it can cause a lot of bleeding, which is not worth the loss. If the diagnosis is suspicious and a biopsy must be performed, the tissue should be taken from the nasal cavity, so that if a major bleeding occurs, the nasal cavity can be blocked to stop the bleeding. 2. The general patients have different degrees of anemia due to severe bleeding. Therefore, in addition to the need to increase nutrition, multivitamins and blood supplements, patients with heavier anemia should undergo several small blood transfusions. 3. The nasal cavity and nasopharynx should be examined in detail before surgery to detect the adhesion of the primary site of the tumor and its surrounding area, so as to make a more accurate estimation of the difficulty of removing the tumor and the amount of bleeding during surgery. 4. Skull base x-ray film to understand whether the skull base is eroded by tumor compression to prevent accidents during surgery. Surgical procedure (1) Through the hard sputum route, this route has the following advantages: it can expose the entire nasopharynx and the bottom of the nasal cavity, directly see the tumor, find the attachment point, facilitate the peeling, and easily pressurize the hemostasis; the incision in the hard palate is easy to heal, no Affects the function of soft palate; no facial scars. 1. The position is supine, the shoulder pad is high, the head is tilted back, and the yarn bag is placed on both sides. And do a good job in the posterior nostril. 2. The incision is made from the posterior edge of the third molar, 1 cm away from the tooth, and a tongue-shaped incision is made along both sides of the hard palate. The large hole should be located inside the incision to prevent accidental injury to the aorta and affect wound healing. 3. Use a stripper to flip the hard palate periosteal flap until the trailing edge of the hard humerus horizontal plate. Expose the large hole and cut off the posterior edge to free the aorta. According to the size and position of the tumor, the hard iliac bone is removed by chisel and rongeur, and the nasal mucosa is cut open to expose the tumor. 4. Freeze the chiller directly onto the tumor for approximately 15 min. Be careful not to frost damage normal tissue. At this time, it can be seen that the tumor shrinks and hardens as it freezes, and when the entire tumor is frozen and hardened, the freezer is taken out. 5. Excision of the tumor The tumor was grasped with a grasping forceps, and the tumor was bluntly peeled off by the peeler, the tumor was gradually lifted up, the base was peeled off with a stripper, and the tumor was taken out. It is not advisable to use scissors to cut off the tumor base to avoid residue. 6. Before and after the nasal hole filling and hemostasis tumors are removed, check for residual residue, and use the prepared gauze and yarn balls to fill the nose and the back of the nostrils to stop bleeding. 7. The suture incision restores the hard palate mucosal flap and sutures the entire layer of silk. 8. Tumor invasion of the pterygopalatine hemangioma of the pterygopalatine can bypass the posterior wall of the maxillary sinus by the nasopharynx sidewall and expand the fissure here into the pterygopalatine fossa. Compression of the ipsilateral maxilla, causing the maxilla to be pushed inward, causing deformity, affecting the occlusion of the ipsilateral teeth, and developing toward the cheeks, pushing the cheeks out of the bulge. This type of tumor is often dumbbell-shaped, located on both sides of the nasopharyngeal cavity and pterygopalatine, and should be added as a lip incision into the pterygopalatine during operation, cutting off the junction of the nasopharynx and pterygopalatine tumors, respectively. And the gum route is taken out. (2) The anterior wall and the inner wall of the maxillary sinus were excised by the nasal approach according to the same method of nasal incision, and the nasal cavity was enlarged and then entered into the nasopharynx, and the nasopharynx tumor was removed by the above method. This approach is used when the nasopharyngeal tumor invades the sinus, the nasal cavity shrinks after surgery, and scars remain in the ankle. complication Loss of appetite is one of the causes of cachexia and a clinical manifestation of cachexia. As with the cachexia of other advanced cancers, patients may experience loss of appetite or anorexia, weight loss, fatigue, anemia, and fever, severe failure and even death.