Bedah sinonasal endoskopik angiofibroma nasofaring belia: laporan seri kasus berbasis bukti (evidence based)

Retno Sulistyo Wardani, Ika Dewi Mayangsari, Lisnawati L, Jacub Pandelaki, Kharisma Prameswari, Endang Mangunkusumo

Abstract


Background: Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign, but locally invasive neoplasm occurring most often in adolescent males. These tumors are highly aggressive andare associated with significant morbidity and mortality due to its tendency to bleed. Purpose: To presentevidence based case-report on endoscopic removal of JNA as an alternative technique besides the openapproach. Cases: Three cases of JNA managed endoscopically of their removal and the difference ofclinical symptoms based on the histopathological variation and radiological description analysis, givingbenefits in endoscopic surgical planning. Management: The classical treatment for JNA is surgery,however there are cases in which may indicate radiotherapy or even hormone therapy and gamma knifesurgery. Recent advances in technology enable ENT surgeons to use the endonasal technique as analternative in treating JNA patients. Conclusion: Endoscopic removal of JNA was successfully performedfor T1 and T2 tumor based on Fisch classification. To support a good management for JNA casesendoscopically, carefull considerations should be made to determine accesses toward the predominant attachment of the tumor to sphenopalatine foramen and pterygoid plate. Rhinologists and OncologyHeadandNecksurgeonsshouldhavedeepunderstandingofendoscopicanatomyoflateralnasalwalland mastering the art of four-hand technique of endoscopic sinonasal surgery.
Keywords : angiofibroma, endoscopic surgery, sphenopalatine artery, pterygoid plate of sphenoid bone.

 



Abstrak :

 

Latar belakang: Angiofibroma nasofaring belia (ANB) merupakan tumor jinak secara histologis,namun bersifat ganas secara lokal yang terjadi terutama pada anak laki-laki usia remaja. Tumor jenis inibersifat sangat agresif dan sering dihubungkan dengan tingginya angka morbiditas dan mortalitas karenakecenderungan tumor yang mudah berdarah. Tujuan: Mempresentasikan 3 kasus dengan diagnosis klinisANB yang dilakukan ekstirpasi secara bedah sinonasal endoskopik. Telaah literatur terstruktur dilakukanuntuk menganalisis keputusan dan aplikasi pemilihan teknik bedah ini. Kasus: Tiga kasus ANB yangtelah dilakukan ekstirpasi dengan bedah endoskopik dianalisis berdasarkan variasi gejala klinis, gambaranhistopatologi dan gambaran radiologiknya yang berguna untuk perencanaan pembedahan sinonasalendoskopik. Penatalaksanaan: Tatalaksana utama ANB adalah dengan pembedahan, namun pada kasuskasustertentudapat dipilih modalitas radioterapi, terapihormon dan pembedahan dengan pisau gamma.KemajuanteknologimemudahkanparaahlibedahTHTuntukmenggunakanpendekatanendoskopisebagaialternatif pendekatan bedah pada pasien ANB.Kesimpulan:Bedah sinonasal endoskopikANBdapatdilakukanuntuktumorberukuranT1danT2berdasarkanklasifikasiFisch.Faktorlainyangharusdiperhatikanuntukkeberhasilantindakanadalahpemahamananatomiendoskopikhidungdansinusparanasal untuk penetapanakses secara sentripetalmenujuperlekatanutamaANBpada foramensfenopalatinadanlempeng pterigoid, serta kerjasama antaraahli Rinologi dengan ahli Bedah KepalaLeherOnkologi dalam teknik bedah sinonasal endoskopik 4 tangan (four-handtechnique).
Kata kunci : angiofibroma, bedah endoskopik, arteri sfenopalatina, lempeng pterigoid os sfenoid.

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DOI: https://doi.org/10.32637/orli.v42i2.31

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