Novel Modifications to Total Maxillary Swing Approach in Extensive Nasopharyngeal Angiofibroma to Minimize Complications
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ORIGINAL ARTICLE
Novel Modifications to Total Maxillary Swing Approach in Extensive Nasopharyngeal Angiofibroma to Minimize Complications Abhishek Bhardwaj1 • Madhu Priya1 • Manu Malhotra1 Amit Kumar Tyagi1 • Arpana Singh2
•
Saurabh Varshney1
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Received: 20 August 2020 / Accepted: 23 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract Maxillary swing approaches provide excellent exposure of the anterior, mid, and anterolateral skull base offering a wide window to approach nasopharyngeal neoplasms; however, they are also associated with complications. The present study aimed to evaluate the results of a modified total maxillary swing (TMS) approach developed to minimize postoperative complications. The modified TMS approach was used to treat five patients who had extensive juvenile nasopharyngeal angiofibromas between March and October 2019 at our tertiary care center. Surgical technique, preoperative image findings, and intraoperative findings were recorded. In the postoperative follow-up, patients were examined to rule out all possible complications associated with the procedure according to the literature. A retrospective analysis was performed to assess tumor extensions, surgical modifications, and
& Manu Malhotra [email protected] Abhishek Bhardwaj [email protected] Madhu Priya [email protected] Saurabh Varshney [email protected] Amit Kumar Tyagi [email protected] Arpana Singh [email protected] 1
Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh 249203, India
2
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, India
postoperative complications. All tumors had orbital and infratemporal (lateral limit) involvement while four had intracranial involvement. No per-operative complications were reported, and postoperative clinical and endoscopic evaluation was performed at 1, 2, and 3 months. There was no evidence of complications including residue, recurrence, maxillary necrosis, ophthalmoplegia, epiphora, palatal fistula, or jaw malocclusion. Besides, minor complications such as infraorbital margin skin retraction, infraorbital serous collection, maxillo-zygomatic abscess, and unsightly scar were also not seen. Only one case presented with maxillary osteomyelitis which was resolved with mini-plate removal and antibiotics. A modified TMS approach is a prudent option to ensure complete removal of juvenile nasopharyngeal angiofibromas with negligible complications. Keywords Nasopharyngeal angiofibroma Extensive Total maxillary swing Complications
Introduction Juvenile nasopharyngeal angiofibromas (JNAs) are benign tumors with high vascularity seen almost exclusively in adolescent males [1, 2]. Currently presumed to arise from the sphenopalatine foramen at its superior margin, it spreads through various communications of the pterygopalatine fossa and leads to local destruction resulting in multiple morbidities [1]. Critical for all surgical approaches is adequate ex
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