Bangladesh boy undergoes rare nasal endoscopic surgery at MGM healthcare
13 year old permanently cured of recurrent JNA
Chennai: MGM Healthcare, a quaternary care hospital in the heart of the city, today announced a successful rare endoscopic surgery performed on a 13-year-old boy from Bangladesh who was suffering from recurrent JNA (Juvenile Angiofibroma). JNA is a rare, benign, nonencapsulated highly vascularized benign tumor that generally located in the nasopharyngeal region which primarily affects adolescent males; accounts 0.5 % of all head and neck tumors and has a 1:1,50,000 general occurrence. However, occurrence of recurrent JNA is extremely rare.
The surgical procedure was led by Prof Dr. Sanjeev Mohanty, Senior Consultant & Head - Institute of ENT, Head & Neck Surgery, MGM Healthcare and his team.
This boy was admitted into MGM Healthcare with spontaneous recurrent nasal bleeding. He had undergone surgical treatment for the same elsewhere around a year ago. Throughout the post-operative period after the first surgery, he continued to bleed through the nose almost every day. Clinical examination, at MGM Healthcare revealed recurrent vascular tumour mass occupying the same area of the pterygopalatine fossa, maxillary and sphenoid sinuses abutting the left orbital wall.
Explaining the rare medical condition, Dr. Sanjeev Mohanty said, “Nasal obstruction and epistaxis are the main symptoms of JNA. Although it is a benign tumor, local destructive pattern with bone erosion is a potential progress of the tumor which can result in morbidity such as severe unprovoked, spontaneous nasal bleeding, as was the case with this boy. Surgery is accepted to be the best treatment option for JNA. Endoscopic, craniofacial and combined approaches can be used according to the tumor size, location and extent. Usually preoperative embolization of the major feeding vessel of tumor is done before surgery as the standard of care. However in this case, the feeder vessels were from the internal carotid system, which makes surgical management very difficult and challenging ”
On the operation day, the patient was intubated in the Department of Neuroradiology, where selective angiography was performed by both femoral artery punctures. To the doctors’ surprise, the main feeding arteries were from the Internal Carotid Artery (ICA) and its branches. Hence the plan to embolize the feeding vessel was abandoned in view of the risk of stroke, and even blindness. After an informed consent from the parents, the boy was taken up for surgery with an intent to start with an endoscopic trans nasal surgical approach without any external incisions but , to convert to open surgical approach if need be with adequate blood products to transfuse as a back up to minimize peri operative risks all round.
The recurrent bleeding tumour was carefully dissected out and totally removed without any injury to the dura mater, cavernous sinus or optic nerve. Intra operative hypotensive anaesthesia and good instrumentation including use of modern energy devices helped control intra operative bleeding and without any need for blood replacement. The operated area was covered with fibrin glue to facilitate good healing during the period of convalescence.
The boy was discharged after the third post-operative day without any complications. The boy was doing fine on post operative review follow up, without any more episodes of bleeding and associated symptoms.
Speaking on the occasion Dr. Prashanth Rajagopalan, Director MGM Healthcare said “MGM healthcare will go leaps and bounds to deliver its mission of bringing quality healthcare services for all. At MGM Healthcare, we believe only in the best — the best of technology, the best of infrastructure but most importantly, the best of clinical expertise. We have a plethora of highly specialised medical professionals from across the country”