Angiofibroma on the upper eyelid causes. Juvenile fibroma of the nasopharynx

Experts cannot exactly name the cause of the development of such a disease as angiofibroma. There are several theories that are used to explain the causes of pathology:

• hormonal theory.

Frequent diagnosis of the disease in children in adolescence suggested that a disturbed hormonal background could become a certain risk factor. However, information regarding this assumption is contradictory: some scientists do not admit the possibility of a negative impact of hormonal imbalance, while others confirm the involvement of the function of the gonads. Experts have not yet made a final conclusion.

• genetic theory.

This assumption is considered one of the most common. Information about the complete or incomplete absence or violation of Y and X chromosomes in the cells of the neoplasm serves as confirmation. These conclusions are not final and require further research.

• Theory of the influence of age.

Some specialists are inclined to consider the disease as a result of age-related changes in the body.

In addition, there are suggestions about the influence of certain factors on the development of the disease.

Risk factors for developing angiofibroma may include:

• injuries of the face, head, nose, etc.;
• inflammatory diseases, especially inflammation chronic course(for example, chronic sinusitis etc.);
• the presence of hazards, poor ecology, unacceptable lifestyle, etc.

Pathogenesis

Angiofibroma can occur at almost any age, in people of any gender and race.

The most common neoplasm of the nasopharynx: angiofibroma develops on the basis of the pharyngeal main fascia and is a basal or basosphenoidal type of tumor. The proliferation covers the surface of the sphenoid bone and/or the area of ​​the posterior ethmoid cells (sphenoethmoidal appearance).

In some cases, the disease begins from the site of the pterygopalatine fossa, spreading to nasal cavity and into the space behind the jaw. This type of growth of angiofibroma is diagnosed in the pterygo-maxillary variant of tumor development.

This neoplasm is considered to be benign, although it often has rapid growth, affecting adjacent tissues, cavities, and sinuses. Angiofibroma, which has grown into the cavity of the cranium, is especially dangerous.

Symptoms of angiofibroma

Angiofibroma outwardly resembles a small (3-15 mm) single nodule, which has clearly defined contours and an elastic structure. The color of the formation can vary from pinkish-yellow to brown.

The nodule, as a rule, rises slightly above the surrounding tissues.

In some cases, the nodule has a rich capillary network and has a translucent structure: this can be seen with a microscope.

The tumor is found in more cases on the mucous tissues of the upper respiratory tract, either on the top or lower limbs, less often - on organs (for example, kidneys).

The first signs of a neoplasm depend on its location. For example, if the nasopharynx is affected, the patient complains of difficulty in nasal breathing, up to its complete absence. Congestion can occur only on one side, aggravated gradually. At the same time, no drops for the nose do not remove this problem.

Over time, snoring appears (even when awake), a feeling of dryness in the throat, one or two-sided hearing loss. There may be frequent pain in the head, bleeding from the nose of a spontaneous nature.

Angiofibroma at the initial stage is not always manifested by changes in the blood picture. In most patients, signs of anemia - a decrease in the number of red blood cells and hemoglobin - are already detected at later pathological stages.

Angiofibroma in a child may resemble signs of adenoids, therefore, in childhood it is customary to differentiate these pathologies.

In children, non-ossifying fibromas and metaphyseal defects are most often diagnosed; these are relatively common skeletal pathologies in pediatric patients.

As the tumor grows, the patient's well-being worsens. Sleep becomes restless, appetite is disturbed, facial features change (deformation and asymmetry are possible).

stages

Juvenile angiofibroma is conditionally divided into several stages:

1. The neoplasm has a limited growth that does not extend beyond the nasal cavity.
2. The neoplasm grows into the pterygopalatine fossa or nasal sinuses.
3. The tumor spreads in the orbit or infratemporal fossa without intracranial growth (stage) or with extradural growth (stage).
4. The tumor is characterized by intradural growth without involvement of the cavernous sinus, pituitary gland, or optic chiasm (stage), or with the involvement of these areas (stage).

Forms

The species classification of the disease is associated with the localization of the tumor, as well as with some of its structural and pathogenetic features.

• Angiofibroma of the nasopharynx is a benign formation that consists of vascular and connective tissue and develops in the nasopharyngeal cavity. Most often, a disease such as angiofibroma of the nose is found in boys. adolescence, therefore it is also called the term "juvenile, juvenile angiofibroma" is the most common neoplasm in pediatric patients.
• Angiofibroma of the skin is often mistaken for a hemangioma: it is a connective tissue formation that looks like a wart. Such a tumor in most cases is round, has a base and penetrates deep into the skin. It is most often found on the upper and lower extremities, as well as in the neck and face. Mostly women 30-40 years old are ill.
• Angiofibroma of the larynx is a benign formation that occupies the region of the vocal cords. A similar term for the disease is vocal cord angiofibroma. The tumor has a reddish or bluish tint, has an uneven structure and is located on the leg. The first signs of the disease are the appearance of characteristic hoarseness up to total loss vote.
• Angiofibromas of the face are located in different parts of it. You can find them at any age. The main clinical symptom of the disease is the sudden appearance of a small dense or elastic growth. There are usually no other symptoms. If the tumor is constantly touched and damaged, then it can bleed and grow rapidly. Often, education is found in the nasal or ear cavities, on the eyelids.
• Angiofibromas of the face in tuberous sclerosis typical manifestations with this pathology. Tuberous sclerosis is a hereditary neuroectodermal disease, the main features of which are convulsive seizures, mental retardation, and the appearance of neoplasms like angiofibromas. Neoplasms are found in more than half of patients suffering from tuberous sclerosis. You can find them already after 4 years of age.
• Angiofibroma of the skull base is the rarest and, at the same time, the most severe form of the disease, in which a benign formation is formed in the bone structure of the skull base. The disease is difficult to diagnose at an early stage, due to its similarity with hypertrophic and inflammatory pathologies of the nasal and pharyngeal region. Angiofibroma of this type is prone to rapid growth with the destruction of the cranial bones and spread to adjacent anatomical brain structures. The overwhelming majority of boys and young people aged 7-25 are ill.
• Angiofibroma of soft tissues often develops in patients on the skin, on the mammary glands, and tendons. Affects predominantly soft tissues on the limbs, in the trunk, face or neck. In some cases, tumor processes develop in the area internal organs- in the uterus, ovaries, lungs, mammary glands.
• Angiofibroma of the kidney is a benign formation that can proceed for a long time without showing any symptoms. Rarely, the disease is detected due to the appearance of pain in the kidney. The disease is cured surgically: with a small size of the neoplasm, dynamic monitoring of the tumor is possible.

Complications and consequences

In itself, such a neoplasm as angiofibroma belongs to a number of benign ones, and only in extremely rare cases can the disease become malignant.

However, tumor development often proceeds rapidly. A rapid increase in education can provoke the destruction of nearby structures: even dense tissues, such as bones, are damaged. Therefore, rapid tumor growth can cause prolonged and massive bleeding (often recurring), deformation of the facial part, disorders and respiratory visual function. In order to prevent complications of angiofibroma, it is very important to determine the presence of a neoplasm in a timely manner and begin treatment.

Diagnosis of angiofibroma

Diagnosis of the disease has its own characteristics. First of all, the doctor during the examination will pay attention to the number of pathological formations, their nature. The patient will be asked questions about the presence of such pathologies in family members and relatives, about the detection of malignant diseases in loved ones, about possible violations from the central nervous system.

If multiple tumor foci are detected, then the patient is recommended to be screened for tuberculous sclerosis or MEN I.

Blood tests will indicate the presence of anemia and inflammatory process in the body. Thus, a decrease in the level of hemoglobin to 80 g / liter and erythrocytes to 2.4 per 10¹² / l can be observed. Blood biochemistry often demonstrates a decrease in total protein, albumin, and an increase in ALT, AST, and alkaline phosphatase.

Tissue biopsy - the study of part of the tissue with a microscope, will allow you to accurately determine the good quality of the neoplasm.

In addition, the doctor often prescribes a blood test for specific tumor markers to rule out malignancy.

Additional instrumental diagnostics often includes fibroscopy or endoscopy. Such procedures are done using a special device - an endoscope, which will allow you to detect and examine the tumor in cavities, for example, in the nasopharynx. This method will help to assess the superficial state of the tumor, visualize the vascular network, determine the presence of an inflammatory reaction.

Angiofibroma treatment

In the vast majority of cases, patients with angiofibromas are prescribed surgery. The volume and type of surgical intervention is selected taking into account the stage and localization of the pathological focus.

If the tumor process has a significant spread and is penetrated by a large number of vessels, then it may be necessary to prepare the patient in advance. This is done to reduce the risk of bleeding during and after surgery.

Treatment may include the following methods:

• X-ray endovascular occlusion - is used when it is impossible to carry out a full-fledged surgical intervention, as the initial stage of radiation therapy. The application of the method allows to reduce the volume of intraoperative blood loss.
• Radiation treatment- helps in about 50% of cases of angiofibroma, but can be accompanied by a large number of complications. For this reason, it is used only when it is impossible to carry out a full-fledged surgical intervention.

Medications

Drug treatment is aimed at eliminating the main painful signs of angiofibroma, as well as at alleviating and prolonging the life of patients.

• When pain occurs, it is recommended to take Baralgin or No-shpu 1-2 tab. up to three times a day. Duration of admission - from one to four weeks.
• To improve the functioning of organs and strengthen blood vessels, Stimol is prescribed in the amount of 1 package twice a day, as well as multivitamin complexes - for example, Duovit 2 tab. daily for 4 weeks, or Vitrum 1 tab. daily for 4-12 weeks.

Combination chemotherapy is used as needed on an individual basis. Can be offered:

• a combination of Adriamycin, Sarcolysin and Vincristine;
• a combination of Vincristine, Decarbazine, Adriamycin, Cyclophosphamide.

For example, such treatment may be applied before and/or after surgery.

vitamins

High-quality treatment of angiofibroma cannot be imagined without vitamin therapy. Eating certain vitamins does not affect tumor growth in any way, but it helps strengthen blood vessels, prevent anemia and normalize the function of the immune system.

• Vitamin A will serve as a prevention of secondary infection, improve tissue turgor and speed up recovery. This vitamin can be obtained by eating plant foods, or purchased in pharmacies in capsules with an oily vitamin solution.
• Tocopherol prevents the formation of blood clots in the vessels, rejuvenates and renews tissues. The drug is available at any pharmacy without a prescription, and is also present in products such as butter and sunflower oil, nuts, seeds and milk.
• Ascorbic acid is involved in the regulation of regenerative reactions in the body, normalizes the production of hormones. Ascorbic acid can be obtained from vitamin preparations or from food products, which include berries, apples, kiwi, citrus fruits, greens, cabbage.
• B vitamins regulate neuroendocrine function. They can be obtained in sufficient quantities by using meat products, nuts, milk.
• Vitamin K improves blood clotting, eliminates minor bleeding. Vitamin is part of many multivitamin products and monopreparations.

Physiotherapy treatment

With angiofibroma, physiotherapy can be prescribed, which enhances the effect of drugs on the tumor. Often, oncode-destructive effects are prescribed: photodynamics, high-intensity laser therapy, decimeter therapy, ultrasound. At the same time, it is possible to use cytolytic techniques, which include, in particular, cytostatic electrophoresis.

Comprehensive treatment of patients who underwent an operation to remove such a neoplasm as angiofibroma includes the following physiotherapeutic methods:

• immunosuppressive procedures (electrophoresis with immunosuppressants);
• chemo-modifying procedures (low-frequency magnetic therapy).

To normalize autonomic disorders, electrosleep therapy, transcranial electroanalgesia, low-frequency magnetic therapy, and galvanization are used.

After complete removal of angiofibroma, contraindications to physiotherapy are of a general nature.

Alternative treatment

To get rid of the tumor - angiofibroma, it is recommended to pay attention to the diet: certain products can help stop the spread of the disease.

• Tomatoes are frequent guests on our table. Experts advise eating five large tomatoes daily, as well as adding to dishes. tomato paste or juice.
• It is recommended to mix beetroot juice with honey in equal parts, and drink it three times a day before meals, 100 ml each.
• Walnuts should be crushed together with the shell, pour boiling water over, leave for fifteen minutes. Proportion - 300 g of nuts per 1 liter of water. The infusion should be taken three times a day for 1 tbsp. l.

A neoplasm of connective tissues and blood vessels is considered a rather rare disease. In oncology practice, very often angiofibroma considered in combination with dermatofibroma. The localization of this benign tumor is the skin and the nasopharynx.

Causes and epidemiology of the disease

Angiofibroma of the nasopharynx was first described by Hippocrates in the 5th century BC. e. But this term began to be called the disease after 1940. The mutation of the cells of the nasopharyngeal space is mainly diagnosed in male patients aged 7-14 years, which is obviously associated with puberty.

Angiofibroma of the skin develops with the same frequency in both men and women. This defeat skin is the result of photoaging of the dermis. That is why older people are considered the most susceptible category.

Angiofibroma of the larynx: clinical picture

Symptoms of the disease include the following signs:

• Chronic nasal congestion, which manifests itself in 80-90% of cancer patients on early stages malignant process.
• Periodic nosebleeds. Blood discharge, as a rule, are unilateral and intense. This symptom is observed in 45% of clinical cases.
• Frequent headaches, which are provoked by constant congestion of the paranasal sinuses.
• Swelling of facial tissues.
• Juvenile angiofibroma with a significant spread, it can provoke a violation of auditory and visual functions.

Symptoms of angiofibroma of the skin

The pathological focus has the form of a dense node, the size of which does not exceed 3 mm in diameter. The color of the tumor can vary from light to dark brown. Such compaction of the epidermis in most cases does not cause subjective complaints in the patient and may long time be in a stable state.

Diagnosis of the disease

Atypical dermal tissue growth is diagnosed based on visual examination, which may be improved by dermatoscopy. The final diagnosis is based on the results histological analysis. To perform a biopsy, a small area of ​​the oncological focus is removed from the patient and performed laboratory analysis biopsy.

Juvenile angiofibroma detected using the following methods:

1. Instrumental examination of the nasal cavity and pharynx.
2. Computed and magnetic resonance imaging. Layered radiological scanning of an atypical area of ​​the body identifies the boundaries, localization and spread of the neoplasm.
3. Biopsy. A cytological biopsy test is necessary to clarify the diagnosis and type of tumor.

Differential Diagnosis

The cutaneous form of the pathology has a very similar clinical picture with and.

Angiofibroma in a child differentiates with polyposis overgrowth, sinusitis and nasopharyngeal cancer.

Angiofibroma of the nasopharynx: treatment

Therapy of angifibroma lesions of the nasopharyngeal space is carried out by the following methods:

hormone therapy

Drug treatment includes the use of testosterone, which blocks tumor growth and causes a 44% reduction in tumor growth.

Radiotherapy

Some cancer centers report a positive result of radiological exposure in 80% of cancer patients. The use has some limitations due to the high frequency of radiological complications. In this regard, oncologists recommend using a stereotaxic technique, which consists in a highly accurate and dosed behavior of radiation to the affected area of ​​the body.

Surgery

Removal of angiofibroma is often complicated by the presence of a dense network of blood vessels. Surgical access to the pathological focus of the nasopharynx is carried out depending on the characteristics of the localization of oncology. For example, lateral nasal incision is indicated for stage 1 and stage 2 tumors; the infratemporal path is used for significant expansion of angiofibroma. Recently, intranasal endoscopic surgery, with which the surgeon excised the neoplasm with minimal trauma to nearby healthy tissues.

Consequences and complications after removal

Despite the key importance of surgical removal of the tumor, radical excision is contraindicated in 10% of clinical cases due to invasion benign neoplasm into the bony structures of the base of the skull. The main complications of such treatment are associated with (30% frequency), surgical bleeding and traumatic damage to adjacent tissues.

The effects of radiation therapy are as follows:

1. The development of radiological inflammation of the mucous membranes, in particular, stomatitis of the oral cavity.
2. Decrease in the concentration of leukocytes and erythrocytes in the blood.
3. Skin complications in the form of dermatitis, itching and swelling.
4. Systemic manifestations of radiation intoxication (insomnia, loss of appetite).

Long-term effects of radiotherapy include atrophy of the skin, asymmetry of the facial skeleton, progressive osteoporosis and the formation of a secondary one.

life forecast

The prognosis of the disease is usually favorable. timely surgery in combination with radiation therapy, lead to a complete cure for the cancer patient.

In rare cases, a negative result of anticancer treatment is observed in the form of recurrence or malignancy of the neoplasm. Statistically, angiofibroma undergoes cancerous transformation in the second or third year after resection rehabilitation period. For timely diagnosis therapeutic complications, patients are advised to undergo annual examinations by an otolaryngologist.

Angiofibroma grows quite fast, however clinical manifestations begin to disturb patients immediately.

• Increasing difficulty in nasal breathing.
• Hyposmia and anosmia (decrease and disappearance of the sense of smell).
• Nasal.
• Hearing loss in one or both ears.
• nosebleeds; as the disease progresses, their intensity and frequency increase.
• Headache.
• Deformation of the facial skeleton (in the later stages leads to displacement of surrounding tissues).

Forms

There are three forms of angiofibroma depending on the direction of its growth:

• the tumor can begin its growth on the vault of the nasopharynx and grow from there to the base of the skull;
• a tumor from the body of the sphenoid bone grows into the ethmoid labyrinth, sinuses, nasal cavity and orbit;
• angiofibroma can also begin its growth in the region of the pterygopalatine fossa and grow into the nasal cavity.

There is a clinical and anatomical classification of juvenile angiofibroma, in which two forms are distinguished:

• basal-common: it is characterized by such clinical symptoms, as difficulty in nasal breathing, anosmia (lack of odor recognition), nasality, hearing impairment (hearing loss in one, less often both ears), inflammation in the paranasal sinuses, signs of compression of II and III branches trigeminal nerve, exophthalmos (bulging eyes) and diplopia (double vision);
• intracranially common: with it, the picture is supplemented by signs of damage to the first branch of the trigeminal nerve, swelling of the disc optic nerve, swelling of the cheek on the side of the spread of the tumor, lesions of II, III and VI pairs cranial nerves- ptosis (drooping of the eyelid), swelling of the eyelid, decreased vision.

• Stage I - the tumor is limited to the nasal cavity;
• Stage II - the spread of the tumor into the pterygopalatine fossa or maxillary, ethmoid or sphenoid sinuses;
• Stage IIIa - tumor spread to the orbit or infratemporal fossa without intracranial growth;
• IIIb stage - stage IIIa with spread outside the dura mater;
• IVa stage - the spread of the tumor under the dura mater without involving the cavernous sinus (a large vein at the base of the brain), the pituitary gland (the coordinator of the activity of all endocrine glands of the body) and the optic chiasm (the area where the optic nerves cross);
• IVb stage - involvement in the tumor process of the cavernous sinus, pituitary gland or optic chiasm.

The reasons

It is believed that this tumor is a consequence of an abnormal development in the embryonic period.

Diagnostics

• Analysis of complaints and anamnesis of the disease:
  • progressive difficulty in nasal breathing;
  • hyposmia and anosmia (decrease or complete absence smell);
  • nasality;
  • hearing loss in one or both ears;
  • nosebleeds;
  • headache;
  • visual disturbances (decreased visual acuity, bulging eyes, double vision, etc.).
• Anterior and posterior rhinoscopy allows you to see a rounded, smooth or bumpy surface of the tumor of a bright red or cyanotic color; during palpation with a probe, the tumor begins to bleed.
• Radiography (sometimes does not allow you to accurately determine the size of the tumor and the space it occupies).
• Computed tomography is a more accurate method for determining the boundaries of the tumor and its size.
• Nasal endoscopy or fibroscopy. Endoscopy is performed after local anesthesia, which saves the patient from discomfort during the procedure. The doctor inserts the endoscope into the nasal cavity through the nostril and examines the nasal cavity.
• Taking a biopsy (a tumor site for further histological examination) is accompanied by a high risk of bleeding, so it is not always used.
• Angiography allows you to visualize the relationship of the tumor with the carotid artery system (important when planning surgical treatment).
• A complete blood count will show anemia due to frequent nosebleeds.
• Consultation is also possible.

Treatment of angiofibroma of the nasopharynx of youth

Treatment is surgical only. It is carried out under endoscopic control (an endoscope is a “ optical instrument”, which is used for a more detailed examination of distant parts of the nasal cavity, provides visual control of the operation).

Operation types:

• operations using access to the tumor through natural routes (through the nose or mouth);
• surgery using gentle access through maxillary sinus and the nasal cavity (with an incision under the lip);
• surgery using extended access through the maxillary sinus and nasal cavity (with a facial incision);
• operation using access through the sky.

Complications and consequences

• The development of profuse intractable bleeding and irreversible neurological complications(for example, loss of visual fields) when the tumor grows into the cranial cavity.
• Spread of the tumor into the nasal cavity.
• Anemia due to frequent, heavy nosebleeds (a condition in which there is reduced content erythrocytes or insufficient amount of hemoglobin in them).

Prevention of angiofibroma of the nasopharynx of youth

• Prevention this disease does not exist.
• When the first signs appear (increasing difficulty in nasal breathing, decreased sense of smell up to its complete disappearance, frequent nosebleeds), indicating the presence of this disease, you should immediately consult a doctor.

Additionally

Benign tumors are pathological formations resulting from a violation of the mechanisms that control cell division and growth. They have a structure similar to the tissues from which they originate (muscle tissue, bone, cartilage tissue, etc.). benign tumors characterized by slow growth. As they grow, squeezing of neighboring organs and tissues occurs. Tumors characterized by benign growth, for the most part, are not prone to recurrence (that is, to the recurrence of the disease after successfully completed therapy), do not metastasize (that is, secondary tumor foci in other organs) and respond well to treatment.

ICD-10 code: D10.6

Benign tumors of the nasopharynx are rare. The most common of these is angiofibroma of the nasopharynx.

Angiofibroma nasopharynx is observed exclusively in males from the age of 10 years. There is an opinion that the tumor undergoes regression by the age of 20-25, but this outcome is not always observed.

a) Symptoms and clinic of angiofibroma of the nasopharynx. The clinical picture includes increasing symptoms of nasal obstruction, purulent rhinosinusitis due to nasopharyngeal obstruction, severe bleeding from the nose and, nasal voice, headache, obstruction of the mouth of the auditory tube, leading to conductive hearing loss, catarrhal or suppurative otitis media.

Posterior rhinoscopy reveals occlusion of the nasopharynx by a smooth grayish-red tumor, which may have a lobed structure and spurs growing into the choanae or pharyngeal pocket (Rosenmuller's fossa). A pronounced vascular network is visible on the tumor wall. In an advanced stage, the tumor can deform the face and bones of the nose, protrude through the cheek and cause exophthalmos. Finally, the swelling makes eating difficult. On palpation, the consistency of angiofibroma of the nasopharynx is dense.

b) Development mechanisms. Angiofibroma of the nasopharynx in typical cases, according to the histological structure, is benign, but causes a severe clinical picture, as it has an expansive and infiltrating growth. The tumor has an uneven surface and is rich in fibrous tissue, originating from the roof of the nasopharynx or pterygoid fossa. Angiofibroma usually emerges from the pterygomaxillary fissure and is soldered to soft tissues nasopharynx.

Angiofibroma grows relatively quickly. After filling the nasopharynx, the tumor spreads to the paranasal sinuses, upper jaw, sphenoid sinus, pterygopalatine fossa, cheek, ethmoid labyrinth and orbit. Finally, it is possible for angiofibroma to grow into the cranial cavity as a result of erosion of the bones of the skull base.

in) Diagnostics. The diagnosis is made on the basis of the results of transnasal endoscopy, examination with a mirror or nasopharyngeal magnifier, as well as CT and MRI. With an extensive tumor process, carotid angiography is indicated; if necessary, superselective angiography is performed with embolization of the branches of the carotid artery.

G) Differential Diagnosis. AT differential diagnosis include hypertrophic adenoids, choanal polyp (usually mild and non-bleeding), lymphoma, chordoma, and teratoma.

P.S. When performing a biopsy, special care is required, given the risk of massive bleeding. In addition, it is impossible to judge the blood supply of the tumor based on the results of the biopsy. Such information can only be obtained with the help of MPT, MRA or angiography.

If juvenile is suspected angiofibroma in a patient aged 10-25 years with a tumor of the nasopharynx, the biopsy should be performed only in a hospital, and the surgeon should be ready for surgery in case massive bleeding occurs. However, characteristic diagnostic signs angiofibromas can also be obtained with angiography.

Chordoma develops from the dorsal string (chord) and occurs mainly in men aged 20-50 years. It grows very slowly, erodes the bones of the base of the skull, affecting the CN, and can also spread to the sphenoid sinus. Treatment. If possible, the tumor should be surgically removed, but the risk of recurrence is high. Radiation therapy is a palliative treatment. Chordoma metastasizes to cervical lymph nodes.

Other tumors. Teratoma, dermoid, fibroma, lipoma. Treatment. If the tumor appears clinically, it should be removed surgically.

e) Treatment of angiofibroma of the nasopharynx. The most effective method of treatment is surgical. There are several approaches for tumor excision: mediofacial “scalping” (midface degloving), transmaxillary and transabdominal approaches. Large tumors may require craniotomy and osteotomy mandible. Smaller tumors are currently removed endoscopically.

Preoperative embolization of the feeding arteries is advisable, which is best performed no earlier than 48 hours before surgery. effective method treatment is also radiation therapy, which is successful in 80% of cases.

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In adolescent children, hormonal changes are sometimes accompanied by the appearance of neoplasms, benign and malignant. They can be formed from different tissues.

The great Hippocrates back in the 5th century BC. described a disease that modern medicine called angiofibroma. This is a benign tumor that appears in the nasopharynx. Its basis is tissue - fibroma (connective) and (vascular). It affects the nasopharynx of boys from 10 years old and young men up to 21 years old (after 20 years, as a rule, regression begins), therefore it is also called "juvenile". Very rarely, the disease overtakes men 28-30 years old.

This neoplasm can grow with deep tissue damage extending to the vessels. And this is a big problem if you need to remove it.

Forms of juvenile angiofibroma

Focusing on the direction of growth of juvenile angiofibroma of the nasopharynx, experts call its forms:

• vault of the nasopharynx (beginning), develops into the base of the skull;
• the body of the sphenoid bone (genesis), growing, affects the nasal cavity, the orbit of the eye, the sinuses, the ethmoid labyrinth;
• from the beginning - the pterygopalatine fossa - into the nasal cavity.

The growth trend of the neoplasm affects the distortion of tissues adjacent to the nasopharynx. A tumor that grows towards the orbit is fraught with displacement of the eyeball, causes a disruption in the blood supply to the brain, and puts pressure on the nerve endings.

With clinical and anatomical classification, two forms are called this disease: basal- and intracranial-common.

The development of neoplasms - angiofibroma of the nasopharynx - is benign character, however, due to the characteristics of growth, predisposition to repetitions, the neoplasm is considered to be malignant.

Symptoms

Since with angiofibromas nearby tissues are very quickly affected, the disease reveals itself as vivid signs:

• a sharp deterioration in hearing (one or two ears);
• (more frequent and become stronger with the growth of the tumor);
• nasality;
• difficulty breathing through the nose;
• debilitating headaches;
• decrease (often disappearance) of smell.

Depending on the direction in which angiofibroma of the nasopharynx spreads, clinical picture added:

• distortion of the facial skeleton, soft and hard tissues;
• weakening the ability to distinguish the smallest details;
• limitation of mobility and damage to the eyeball (displacement or protrusion);
• diplopia;
• asymmetry of the face, lowered upper eyelids;
• swelling of the cheek (on the side affected by the tumor).

Disease recognition

Diagnosis of pathology - angiofibroma of the nasopharynx - the result of examining the patient, analyzing his complaints and conducting:

• MRI - subject to the skull or nasopharynx (to determine the size and border of the tumor);
• x-ray examination of the arteries;
• endoscopy ();
• a biopsy (of affected tissues for research) is fraught with bleeding, is performed in cases of emergency;
• a thorough examination of the nasal cavity with the help of instruments (rhinoscopy) shows the surface (nature and color of the tissue) of the neoplasm;
• x-ray examination of the blood vessels shows whether it is affected carotid artery a tumor (important to know with an inevitable operation).

Mandatory general analysis blood to determine the level of hemoglobin. Sometimes a consultation with an oncologist is prescribed.

When establishing a diagnosis, it is important to distinguish angiofibroma from the clinic with adenoids, brain tumors, polyps, papillomas, and sarcomas.

Treatment

Angiofibroma of the nasopharynx involves decisive action in the treatment - surgery. Before surgical removal of the neoplasm, it is usually carried out radiation therapy. Since there is a high risk of bleeding during operations, the external carotid artery is often ligated.

Operations to remove angiofibromas are carried out using an endoscope for a detailed examination of remote areas of the nasal cavity.

Surgical intervention under general anesthesia, is selected depending on the site of the malignant formation by:

• approach to the tumor through the nose or mouth;
• in an easier way - with a dissection under the lip (through the nasal cavity and sinus of the upper jaw);
• deployed passage - facial incision;
• access through the sky.

If during the operation the patient suffers a large loss of blood, a donor transfusion is required. In the postoperative stage, the doctor prescribes:

• antibiotics (protection against possible infection);
• transfusion of solutions that replenish blood loss;
• medicines that promote blood clotting.