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Abstract

Object: To determine the incidence and management of nasopharyngeal angiofi broma at JPMC, Karachi from January 1981 to August 2014 (33 years). Design: Descriptive, retrospective study. Subjects & Method: Th e study was conducted at JPMC from January 1981 to Aug 2014 (33 Years). Th e data includes age of patients, gender, clinical presentation, staging, mode of treatment, status of pre-op embolization, surgical procedures performed, complications and recurrence rate. Results: Total number of cases were 386; males were 381 and females were 05. Minimum age was 13 years and maximum was 36 years and median age was 17.5 years. According to stage, they were 8% patients presented with stage-I disease, 39% of patients presented with stage-II disease, 42% of stage-III, 8% of stage IVa and 3% with IVb. Geographically 48% were from hot/ desert areas and 52% were from cold/high altitude areas. Commonest symptom was nasal obstruction presented in 98% of the patients and among them 75% was of unilateral. Epistaxis was present in 70%, surgical excision was performed in 375 patients while radiotherapy was done in 11 patients of stage IVb disease. Embolization was done in 297 patients while 78 patients were not embolized due to non availability of the facility earlier. Surgical approach commonly adopted was lateral rhinotomy in 300 patients. Mid facial degloving was performed in 33 patients, endoscopic excision was done in 14 patients and transpalatal route was chosen in 28 patient. Complications of surgery were kept in record from 2011 to till date. Major complications were massive bleeding which was seen in 04 patients, cutaneous fi stula near medial canthus of eye was seen in 02 patients, lymphedema near upper lip was noted in 01 patient and ectropion was seen in 01 patient. Recurrence was seen in 7.8% (n=30). Follow up was done aft er 3 months and 6 months and then for 1 year. Conclusion: Th is is a common vascular tumor in Pakistan reported from both hot and cold areas. Nasopharyngeal angiofi broma is rare in females but 5 were reported and their genetic analysis was done. Before preoperative embolization era, recurrence was uncommon but more blood transfusion was required. Aft er preoperative embolization the recurrence has increased but blood transfusion has reduced. Earlier patients presented in late stage but now they present usually by stage II and III.

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