Otorhinolaryngology

Biography

Mirian Cabral M . Castro, has been working at Faculty of Medicine and taking care of needy people in a public hospital, Santa Casa de Belo Horizonte, with more than 1000 beds as head of ORL and HNS department. Over the years developing skills in surgical treatment, studying, learning and teaching as team leader to improve healthcare and graduating new specialists.

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) is a benign, vascular neoplasia, representing less than 5 percent of head and neck tumors which occur almost exclusively in male adolescents with a clinical presentation of nasal obstruction and repeated epistaxis. It has slow growth patterns around the sphenopalatine foramen and can expand into the nasal cavity, maxillary sinus, pterygomaxillary space, infratemporal fossa, orbit and middle cranial fossa. The infratemporal fossa (ITF) communicates with the orbit through the inferior orbital fissure, with the middle cranial fossa through the foramen spinosum, the pterygopalatine fossa (PPF) via the pterygomaxillary fissure, and the parapharyngeal space inferiorly. ITF remains one of the most difficult areas to access surgically. Traditionally, this area has been approached with a variety of techniques, but the visualization and surgical procedures are still limited due to its deep location within the surgical field. As technology improved, new instrumentation and experience resulted in the ability for treatment with a curative intent and good results. The preoperative arterial embolization has been used 24 to 48 hours before surgery, allowing endoscopic management in special patients. Employing endoscopic surgical approaches, the need for facial incisions, facial disarticulating osteotomies, or dissection of the facial nerve are eliminated, which may decrease surgical morbidity. Many endoscopic skull base surgeons consider endoscopic approaches a favorable alternative to more traditional open routes. Advantages of endoscopic access to the ITF include a magnified and multiangle view, ability to define clear dissection planes between the tumor and the surrounding structures, and improved visualization. The 2-surgeons technique can be used to provide better instrumentation and to avoid the necessity of traction when dissecting tumors from potentially hazardous areas.