Skull Base Condition (Juvenile Angiofibroma)

What is Juvenile Angiofibroma?

This is a rare tumour almost exclusively seen in males. (If the patient is female consider chromosomal analysis.) It originates from the sphenopalatine foramen and is locally invasive but not malignant. It is a combination of fibrous tissue with endothelial spaces in vascular tissue.

Presentation
->Recurrent epistaxis in young male (average age 14)
->Large posterior nasal mass
->Pulsatile mass palpated prior to adenoidectomy
->Nasal obstruction

Investigations
->Clinical examination with endoscope
->CT scan and MRI
->Angiography
->Do not do a biopsy for fear of life threatening haemorrhage

Management

The treatment is surgical removal, with pre-operative embolisation to reduce the blood loss during the operation. There are several ways to gain accessto the area, but the most common is via the midface in an operation called midfacial degloving.

Skull Base Condition (Nasopharyngeal Carcinoma(NPC))

What is Nasopharyngeal Carcinoma?

There are two distinct types of this types of this cancer of the back of the nose:
->Undiffenrentiated non-keratinizing squamous cell carcinoma (SCC)- this is more common in
people from Southern China and Chinese people from Hong Kong. It is associated with EBV.
->Differentiated keratinizing SCC- this has similar at risk groups to the majority of head and
neck cancers.

Presentation
->Epistaxis
->Nasal obstruction
->Lymph node metastasis
->Middle ear effusion
->Extensive tumours can involve the skull base and cause cranial nerve palsies.

Investigations
Patients will be given a CT and/or an MRI scan

--*Important*--
Every patient presenting with a unilateral middle ear effusion must have their postnasal space visualized to exclude an NPC.

Treatment
Radiotherapy is given for all stages. Neck dissection may be necessary if there are extensive lymph node metastases.