Diseases of nasopharynxDiseases of nasopharynx

DEFINITION of PHARYNXDEFINITION 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 .

NASOPHARYNXNASOPHARYNX

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 adenoidsThe 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 adenoidectomyIndications 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 whenAdenoidectomy 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

AdenoidectomyAdenoidectomy

• 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 CURETTESADENOID CURETTES

Laser adenoidectomyLaser adenoidectomy

JUVENILE NASOPHARYNGEALANGIOFIBROMA

definition

angiofibromas are highly vascular, non-encapsulated tumours affecting predominantly young males.

These lesions are benign histologically but they may become life-threatening with excessive bleeding or intracranial extension.

JUVENILE NASOPHARYNGEAL ANGIOFIBROMAJUVENILE NASOPHARYNGEAL ANGIOFIBROMA

STUDY PERIOD – 1984 TO 2004STUDY PERIOD – 1984 TO 2004

60 CASES60 CASES

ALL CASES EVALUATED ACCORDING TO A QUESTIONNAIRE

FOLLOWUP – 18 MONTHS TO 4 YEARS

PRE-OP TRACHEOSTOMY IN ALL PATIENTS

JUVENILE NASOPHARYNGEAL JUVENILE NASOPHARYNGEAL ANGIOFIBROMAANGIOFIBROMA

60 CASES60 CASES

ALL MALES

AVERAGE AGE – 17 YEARS

(RANGE 12-22 YRS)

JUVENILE NASOPHARYNGEAL ANGIOFIBROMAJUVENILE NASOPHARYNGEAL ANGIOFIBROMA

COMMON PRESENTATIONCOMMON PRESENTATION

N = 60N = 60

EPISTAXIS

NASAL BLOCKAGE

EAR COMPLAINTS

FACIAL SWELLING

C T SCANC T SCAN

ANGIOGRAPHYANGIOGRAPHY

TUMOUR BLUSHTUMOUR BLUSH

JUVENILE NASOPHARYNGEAL ANGIOFIBROMAJUVENILE NASOPHARYNGEAL ANGIOFIBROMA

COMPLICATIONSCOMPLICATIONS

PRIMARY HAEMORRHAGE – 1 L (Ave)

SECONDARY HAEMORRHAGE – 3 PATIENTS

WOUND INFECTION – 3 PATIENTS

CONDUCTIVE HEARING LOSS – 1 PATIENT

HYPERTROPHIED SCAR – 3 PATIENT

JUVENILE NASOPHARYNGEAL ANGIOFIBROMAJUVENILE NASOPHARYNGEAL ANGIOFIBROMA

FOLLOWUPFOLLOWUP18 MONTHS TO 4 YEARS18 MONTHS TO 4 YEARS

RECURRENCE

11 PATIENTS (18.3 %)

JUVENILE NASOPHARYNGEAL ANGIOFIBROMAJUVENILE NASOPHARYNGEAL ANGIOFIBROMA

CONCLUSIONSCONCLUSIONS

SURGERY IS THE TREATMENT OF CHOICESURGERY IS THE TREATMENT OF CHOICE

MOST COMMON PRESENTATION IS EPISTAXISMOST COMMON PRESENTATION IS EPISTAXIS

BEST APPROACH IS TRANSPALATAL WITH LAT. BEST APPROACH IS TRANSPALATAL WITH LAT. RHINOTOMYRHINOTOMY

FOLLOW UP CT SCAN AFTER 6 MONTHSFOLLOW UP CT SCAN AFTER 6 MONTHS