비인강에의 새로운 Hemipalatal Approach

Abstract

The juvenile nasopharyngeal angiofibroma is an uncommon, highly vascular, locally invasive, non·encapsulated tumor of adolescent males. In the treatment of the nasopharyngeal angiofibro' rna, surgery is considered to be the method of choice. However, due to its relative anatomical inaccessibility, severe extension, and difficulties in controlling the bleeding, the successful exci· sion of the nasopharyngeal angiofibroma is difficult with high rate of recurrence. Many surgical approaches and their modifications were proposed for direct visualization of the nasopharynx and wide exposure of the operative field so as to shorten the operation time with significant reduction in blood loss. These include transpalatal nasopharyngotomy, lateral rhinotomy (Denker, 1926), sublabial transantral approach (Allen & Siegl , 1981; Anand & Conley, 1983; Sardana, 1965), medial or lateral mandibulotmy approach (Kremen, 1953), and neurosurgical craniotomy approach. Two or more approaches may be needed and complete removal in tandem depend upon the extension of the tumor. The authors design an approach that would almost expose the whole extent of the tumor and allow complete resection of the tumor under direct vision and in this way decrease blood loss and the possibility of leaving residual tumor. With this approach, sublabial transantral expo sure is possible as one stage by simple exten· sion of the incision. Its safety was revealed by preceding experimental study using cats. Oper· ative procedures, advantages, and the result of this hemipalatal flap will be discussed