Diseases of nasopharynx
DEFINITION of PHARYNX
• The pharynx is that part of the digestive
tube which is placed behind the nasal
cavities, mouth, and larynx. It is a wide
musculomembranous tube, somewhat
conical in form, with the base upward, and
the apex downward, extending from the
under surface of the skull to the level of
the cricoid cartilage in front, and that of the
sixth cervical vertebra behind .
NASOPHARYNX
It lies behind the nose and above the level of the soft
palate.
It differs from the oral and laryngeal parts of the pharynx in
that its cavity always remains patent.
In front it communicates through the choanæ with the
nasal cavities.
On its lateral wall is the pharyngeal ostium of the
auditory tube, somewhat triangular in shape, and
bounded behind by a firm prominence, the torus or
cushion,.Behind the ostium of the auditory tube is a
deep recess, the pharyngeal recess (fossa of
Rosenmüller).
On the posterior wall is a prominence, best marked in
childhood, produced by a mass of lymphoid tissue, the
adenoids.
The adenoids
• are a clump of lymphoid tissue similar to
that of tonsils, but located higher up in the
throat, behind the nose. Adenoids help the
body fight infections by trapping and
fighting micro organisms as they pass
through the breathing passage.
Indications for adenoidectomy
• Adenoidectomy is indicated if there is a
chronic effusion in the middle ear in an
adult, especially on one side only, which
does not resolve relatively rapidly (3-6
weeks) with proper medical treatment.
• Obstruction behind the nose causing
snoring, airway obstruction, or poor sleep
Adenoidectomy Indicated when
Enlarged adenoids are blocking the airway, which
may be suspected if the child
snores excessively
has trouble breathing through the nose
has episodes of not breathing during sleep
The child has chronic ear infections that:
interfere with child's education
persist despite antibiotic treatment
recur 5 or more times in a year
recur 3 or more times a year during a 2-year period
Adenoidectomy
• The adenoids normally shrink as the child
reaches adolescence and adenoidectomy
is rarely needed after reaching the
teenage years. Adenoidectomy can done
as an outpatient procedure in good set
ups.. Complete recovery takes 1 to 2
weeks. While healing, the child may have
a stuffy nose, nasal drainage, and a sore
throat. Soft, cool foods and drinks may
help relieve throat discomfort.
ADENOID CURETTES
Laser adenoidectomy
JUVENILE NASOPHARYNGEAL
ANGIOFIBROMA
definition
angiofibromas are highly vascular, nonencapsulated tumours affecting
predominantly young males.
These lesions are benign histologically but
they may become life-threatening with
excessive bleeding or intracranial extension.
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
STUDY PERIOD – 1984 TO 2004
60 CASES
ALL CASES EVALUATED ACCORDING TO A
QUESTIONNAIRE
FOLLOWUP – 18 MONTHS TO 4 YEARS
PRE-OP TRACHEOSTOMY IN ALL PATIENTS
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
60 CASES
ALL MALES
AVERAGE AGE – 17 YEARS
(RANGE 12-22 YRS)
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
COMMON PRESENTATION
N = 60
EPISTAXIS
NASAL BLOCKAGE
EAR COMPLAINTS
FACIAL SWELLING
C T SCAN
ANGIOGRAPHY
TUMOUR BLUSH
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
COMPLICATIONS
PRIMARY HAEMORRHAGE – 1 L (Ave)
SECONDARY HAEMORRHAGE – 3 PATIENTS
WOUND INFECTION – 3 PATIENTS
CONDUCTIVE HEARING LOSS – 1 PATIENT
HYPERTROPHIED SCAR – 3 PATIENT
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
FOLLOWUP
18 MONTHS TO 4 YEARS
RECURRENCE
11 PATIENTS (18.3 %)
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
CONCLUSIONS
SURGERY IS THE TREATMENT OF CHOICE
MOST COMMON PRESENTATION IS EPISTAXIS
BEST APPROACH IS TRANSPALATAL WITH LAT. RHINOTOMY
FOLLOW UP CT SCAN AFTER 6 MONTHS