Objective:To investigate the anatomic origin of juvenile nasopharyngeal angiofibroma（JNA） through radiologic analysis of tumor invasion patterns, providing insights into tumor etiology and surgical recurrence prevention. Methods:This retrospective cohort study included primary JNA cases at the Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University from March 2015 to September 2024. All patients underwent preoperative high-resolution CT（HRCT） scans, and some underwent enhanced magnetic resonance imaging. The study retrospectively analyzed the patients' imaging data to examine tumor invasion into the pterygopalatine fossa and the vidian canal. These sites were categorized into non-invaded, partially invaded, and completely invaded for the pterygopalatine fossa and the vidian canal. The study analyzed the proportions of invasion at these sites to further speculate on the origin of JNA. Results:A total of 105 JNA patients were included in the study. Among them, 100% of the patients had complete tumor invasion in the pterygopalatine fossa. For the vidian canal, the proportions of complete invasion, partial invasion, and non-invasion were 54.3%, 27.6%, and 18.1%, respectively. As the staging of JNA tumors increased, the proportion of vidian canal invasion also increased. Conclusion:Our evidence suggests that the pterygopalatine fossa, rather than the vidian canal, might be the likely origin of JNA, which is enlightening for the study of the etiological mechanisms of JNA.
Humans ; Nasopharyngeal Neoplasms/pathology* ; Retrospective Studies ; Angiofibroma/pathology* ; Neoplasm Invasiveness ; Pterygopalatine Fossa/pathology* ; Female ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed ; Adolescent

BACKGROUND: The endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa (PPF) and infratemporal fossa (ITF). Herein, this study aimed to describe a modified approach for resection of the tumors in these areas, both in cadaveric specimen and clinical patients. METHODS: The 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study. For the cadaveric specimens, ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach. The exposure areas were compared between two groups and main anatomic structure were measured. Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy. Perioperative management, intraoperative findings and postoperative complications were recorded and analyzed. RESULTS: The modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did. The diameter of maxillary artery in the PPF was 3.77 ± 0.78 mm (range: 2.06-4.82 mm), the diameter of middle meningeal artery in the ITF was 2.79 ± 0.61 mm (range: 1.54-3.78 mm). Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal. The main complications were facial numbness and pericoronitis of the wisdom tooth. No permanent complication was found. CONCLUSIONS With the widespread use of neuroendoscopy, the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF, which has significant advantages on less trauma and complications to the patients.
Adult ; Female ; Humans ; Infratentorial Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neuroendoscopy ; Perioperative Care ; Postoperative Complications ; Pterygopalatine Fossa ; pathology ; surgery

BACKGROUND: Schwannomas are benign tumors of ectodermal origin derived from Schwann cells of the nerve sheath. Approximately less than 4% of these tumors are found in the paranasal sinuses and there has been little information reported concerning the presentation and surgical management of sinonasal schwannomas. The purpose of this study was to analyze the clinical data, management, and long-term outcomes of sinonasal schwannomas. METHODS: Retrospective chart review of patients with sinonasal schwannomas treated from January 2001 to March 2012 was performed. Clinical data and follow-up information were obtained from a review of the patients' charts and the operative, anesthesia, and pathology reports. RESULTS: There were 4 females and 4 males included in this study. The mean age was 37.5 years (range, 22-51 years). The mean tumor size was 3.1 cm (range 1.0-6.0 cm). The origin of the tumors included: nasal septum (n = 2), nasal vestibule (n = 2), pterygopalatine fossa (n = 2), ethmoid sinus (n = 1), and inferior turbinate (n = 1). Seven patients had endoscopic resections and one patient with a schwannoma in the nasal vestibule underwent a sublabial approach. The mean follow-up was 59 months. There were no tumor recurrences during the study period. CONCLUSIONS: Schwannomas in sinonasal cavity can be treated effectively with the endoscopic approach with minimal morbidity and long-term disease control.
Anesthesia ; Ectoderm ; Ethmoid Sinus ; Female ; Follow-Up Studies ; Humans ; Male ; Nasal Septum ; Neurilemmoma* ; Paranasal Sinuses ; Pathology ; Pterygopalatine Fossa ; Recurrence ; Retrospective Studies ; Schwann Cells ; Turbinates