Juvenile Nasopharyngeal Angiofibroma (JNA) - Causes, Symptoms and Signs
Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of blood vessels in the nasopharynx are histologically benign but clinically malignant because of their destructive nature of bones and extends into the surrounding tissue, for example : to the paranasal sinuses, cheek, eye socket or skull (cranial vault), very easy to bleed and difficult to stop.
Another term for angiofibroma in the literature include: juvenile angiofibroma, juvenile nasopharyngeal angiofibroma, JNA, nasal cavity tumors, nasal tumors, benign nasal tumors, nasal tumors (tumors of nose), nasopharyngeal tumors, nasopharyngeal angiofibroma.
Causes
The exact cause could not be determined.
Theories about the causes of non paraganglionic chromaffin cells of the terminal branches of the maxillary artery also postulated.
The results of comparative genomic hybridization analysis of these tumors revealed deletions also managed to chromosome 17, including the tumor suppressor gene p53 to the same as Her- 2 / neu oncogene.
Various theories commonly cited. One of them is the theory of the tissue of origin, namely the idea that a specific attachment angiofibroma is on the roof of the posterolateral wall of the nasal cavity.
Nasopharyngeal angiofibroma is a benign but locally invasive and damaging surrounding structures . Can be expanded into :
a. Nasal cavity causing nasal obstruction, epistaxis and nasal discharge.
b. Paranasalis sinuses. Maxillary sinus, sphenoidalis and ethmoidales all be attacked.
c. Pterygomaxillary fossa, infratemporal fossa and cheek.
d. Orbital give symptoms of proptosis and deformity "face - frog". Sign in with inferior orbital fissure and also damage the apex of the orbit. Can also enter the orbit through the superior orbital fissure.
e. Cranial cavity. Cranial fossa media most frequently.
Symptoms
1. Nasal obstruction (80-90 %) and mucus (rhinorrhea). This is the most frequent symptom, especially at the beginning of the disease.
2. Frequent nosebleeds (epistaxis) or discharge from the nose is the color of blood (blood - tinged nasal discharge). Nosebleeds, which ranges from 45-60 %, typically one-sided (unilateral) and recurrent.
3. Headache (25 %), especially if the paranasal sinuses blocked.
4. Swelling in the face, it happened about 10-18 %.
5. Conductive hearing loss from eustachian tube obstruction.
6. Diplopia that occur secondary to erosion into the cranial cavity and the pressure to the optic chiasm.
7. Other symptoms may also occur such as : unilateral rhinorrhea, anosmia, decreased sensitivity to smell (hyposmia), recurrent otitis media, eye pain, deafness, ear pain, swelling of the palate, deformity of the cheek, and rhinolalia.
Signs
1. Appears grayish red mass visible in the posterior nasal pharynx ; nonencapsulated and often lobulated ; sessile or pedunculated. The incidence of nasal mass reaches 80 %.
2. Proptosis, a bulging palate, buccal mucosa an intraoral mass, cheek mass, or swelling of the zygoma (generally accompanied by local extension). The incidence of orbital mass is about 15 %, whereas the incidence for bulging eyes (proptosis) about 10-15 %.
3. Other signs include : serous otitis due to obstruction of the eustachian tube, zygomaticus swelling, and trismus (spasm of the jaw muscles) which is a sign that a tumor has spread to the infratemporal fossa. There is also a decrease in vision due to optic nerve tenting, but this rarely happens.
