Juvenile Nasopharyngeal Angiofibroma (JNA) remains one of the most enigmatic tumors encountered by laryngotologists-head neck surgeons. Its origin at a particular age in a particular sex has intrigued many. Histopathologically benign, JNAs are locally aggressive tumors with tendency to cause massive recurrent nasal bleeds. While surgery remains the gold standard treatment, a paradigm shift from open approaches to endoscopic approach is noted. Recent advances in genomic testing, radiodiagnosis and endoscopic nasal surgeries allow us to manage these tumors more efficiently. Introduction of intensity modulated radiotherapy (IMRT), stereotactic surgery, and interventional radiology (embolisation) has further helped in this cause. This chapter aims to give a brief overview of all these aspects related to JNA with the hope to initiate more ENT surgeons to contribute to further research on this benign but dangerous tumor.
Part of the book: Pharynx
Adenoid, also known as the Luschka’s or nasopharyngeal tonsil, is a mass of lymphoid tissue located in the roof of nasopharynx. The term ‘adenoid’ was coined by Meyer. Earliest records of adenoid surgery date back to 1842, when Yearsley reported removal of mucus membrane from behind the uvula to improve ear function. Other techniques for adenoidectomy included bare fingernails or finger ring knife, which are considered obsolete now. From mid-1930s to early 1960s, radiation therapy of the adenoid was used extensively. Transoral adenoid curetting and electrical dissection techniques followed and became mainstay of treatment for a long time. Infact, these are still in use in many centres across the world. Like any other surgery, introduction of nasal endoscopes and powered instruments revolutionised adenoid surgery by greatly increasing the precision and minimising collateral damage. Plasma-mediated ablation (Coblation) promises ‘blood-less’ surgery. Presently, the trend is focussed towards using powered instruments (Microdebrider and/or Coblation) under endoscopic visualisation for complete adenoidectomy.
Part of the book: Tonsils and Adenoids