بسم الله الحمن الرحيم (قل ان صلاتي و نسكي و محياي ومماتي لله رب العالمين لا شريك له وبدلك امرت وأنا اول المسلمين) طه 25-28

Nasopharyngeal tumors Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine

NP tumors divided into: A- Benign tumors: benign tumors of NP are uncommon, they include: -papilloma - adenoma - angiofibroma. B- malignant tumor: -NP carcinoma.

Angiofibroma: This rare tumor occur exclusively in boys around the age of puberty. Site of Origin: Originates in close proximity to the posterior attachment of the middle turbinate, near the superior border of the sphenopalatine foramen.

Symptoms: Nasal obstruction (90%) Epistaxis (60%): unilateral, recurrent & severe. Headache (25%) Especially if paranasal sinuses are blocked Facial swelling (10%) Other symptoms - anosmia, hyposmia, deafness, otalgia, swelling of the palate, deformity of the cheek.

Signs: Nasal mass (80%) tumor is usually sessile, lobulated, rubbery, and grey-pink appearance. Orbital mass (15%) Proptosis (10-15%) MEE Zygomatic swelling Trismus

CT scan: Images demonstrate extent of the tumor. Angiography: Shows the branches of the external carotid system to be the primary feeders. The main supply comes from the internal maxillary artery, but ascending pharyngeal or vidian arteries may contribute to the blood supply. Essential for embolization.  Before & after embolization → After

Management: 1- surgery after embolization. Using traspalatal or midfacial deglving. 2- Radiotherapy: Some centers have reported 80% cure rates with conventional radiation therapy. 3- endoscopic sinus surgery (FESS). Recently developed Specially for simple cases.

Uncommon malignant disease (incidence less than 1 per 100,000). Male-to-female ratio is 3:1. Median age is 50 years. Site of Origin: NPC most commonly starts in Fossa of Rosenmüller. Nasopharyngeal Carcinoma

Spread:  to retropharyngeal & jugulodigastric LN.  Locally to base of skull, PNS.  distant to lung, liver & bones.

Presentation:  lump in neck: commonest presentation (75%) of the cases.  nasal symptoms: epistaxis or obstruction.  Trotters triad: -Unilateral CHL. - trigeminal neuralgia. -Immobility of soft palate due to direct infiltration.  CN paralysis: occur later.

Diagnosis: CT: Demonstrate the soft tissue extension in the nasopharynx and laterally into the paranasopharyngeal space. It is sensitive in detecting bone erosion, especially that of the skull base. CT scan show bone regeneration after therapy, which indicates complete eradication of tumor.

Endoscopic Examination & Punch Biopsy: can be under LA or GA Better after CT scan, why. MRI: Differentiating tumor from inflammation of soft tissues. More sensitive at evaluating retropharyngeal and deep cervical nodal metastases. Detect bone marrow infiltration by tumors.

Treatment: Radiotherapy: Is the ROC in NPC Chemotherapy: Role of surgery: it is limited because of early spread of tumor. The only indication is radical neck dissection of LN after successful radiotherapy

Dr. Abdussalam