COMMON PRESENTING SYMPTOMS DIAGNOSIS AND MANAGEMENT OF ANGIOFIBROMA - A study of twenty cases

Objective: To determine common presenting symptoms, age, disease extent; and the efficacy of different surgical approaches in the diagnosis and treatment of Angiofibroma of nasopharynx. Design: All prepubertal and adolescent patients presenting with nasal obstruction, recurrent epistaxis, denasal speech, conductive deafness and anaemic look, reporting to our dept for consultancy were evaluated. Setting: Patients were diagnosed on the basis of history, clinical examination, and CT scan with contrast. Tumour excision was performed through lateral rhinotomy; lateral Rhinotomy plus Weber, Weber Fergusson and U-shaped trans palatal approaches. Subjects: Twenty patients with suggestive history, clinical examination and CT scan findings were operated for excision of tumour. Main Outcome Measures: CT scan with contrast was found most valuable investigation. Lateral rhinotomy incision was found useful for angiofibromas with extension into pterygopalatine fossa, and Weber-Fergusson approach for tumors occupying infratemporal fossa. Results: All patients were male, mean age 17.25 years. 80% presented with epistaxis, 10% with denasal speech and conductive deafness. Tumour was excised through lateral rhinotomy 8 (40%), lateral Rhinotomy plus Weber in 4 (20%). Weber Fergusson 4(20%) and U-shaped trans palatal 4(20%). Tumor was limited to nasopharynx (4(29%), retromaxillary space 8(40%), into pterygopalatine fossa 6(30%), and infratemporal fossa 2 (10%). All tumors were excised completely. Conclusion: Angiofibroma of nasopharynx should be suspected in young adolescent males presenting with epistaxis or denasal speech. CT scan with contrast is the key investigation and lateral rhinotomy alone or in combination with Weber is suitable for tumours of nose, nesopharynx or more widespread.