COLUMBUS, Ohio—Juvenile Nasopharyngeal Angiofibroma (JNA) is a benign tumor around the cheek area, occurring exclusively in adolescent boys. The symptoms, which are easy to overlook initially, include repeated nose bleeds, nasal congestion, nasal discharge and hearing loss. If left untreated, boys with the condition can bleed to death.
JNA accounts for 0.05 percent of all head and neck tumors, at a frequency anywhere from 1:5,000-1:60,000 boys. Onset is most common between the ages of 7 and 19. Girls with JNA are genetically tested because of the hormones involved.
The most common method of removing such a tumor has been extensive, bloody surgery that leaves the patient with facial scars from the cutting. Surgeons would remove half of the cheek, and the front part of the neck in order to find the blood supply and remove the tumor. As a result, patients usually lost up to a quart of blood.
Doctors of interventional radiology and ears, nose & throat surgery at Columbus Children’s Hospital are teaming up to save teenagers from living with the physical and emotional scars of that surgery for the rest of their lives. The collaborative procedure is far less invasive, and patients lose less than a half of a cup of blood.
Doctor William Shiels and Doctor Richard Kang performed the collaborative procedure using interventional radiology to stop the blood supply to the tumor, then fiberoptic endoscopy to remove the tumor on 13-year-old Matthew Sexton. They saved his life, and allowed him to remain a handsome kid at the same time.
On day one of the procedure Dr. Shiels, chief of radiology at Children’s, inserted a catheter through Matthew’s leg and used high-tech imaging to map every blood vessel supplying the tumor. He then injected tiny beads into those vessels to cut off the flow of blood to the tumor. On day two of the procedure, Dr. Kang, chief of the Department of Otolaryngology at Children’s, removed the tumor through Matthew’s nasal cavity.
Shiels said the benefits of the collaborative procedure include reducing the need for blood transfusions; getting rid of the tumor safely, and less deformity for the child.
“Thirteen year old boys are self conscious,” Shiels said. “They are developing their self image, and if there is deformity visible to everyone he meets at first glance, it can be a life changing event and affect him through his whole adult life.”
In addition to the reduction of scaring and blood loss, there is also a reduction in recovery time. After the extensive surgery, typically the patient endures a week of pain and swelling in recovery. Matthew felt no pain after the collaborative surgery, and was able to go home the next day.
The procedure has been in use for the last 5 to 10 years, but is not widely practiced. Kang said more doctors around the country do not perform this procedure because of a reluctance to proceed without open access to the tumor.
“Sinal surgery is a simpler and quicker way to go,” Kang said. “But, because if you were to get into any trouble, your ability to get to the source of bleeding and stop it [is limited], the stress level is higher. ‘Big incisions for big surgeries’ was the old school of thought, but now we can do big surgeries with small incisions.”
Shiels said doctors at Columbus Children’s train interventional radiologists around the world in this procedure.