Lateral Extensions of Nasopharyngeal Fibroma

NASOPHARYNGEAL FIBROMA is an uncommon disease, constituting one in every 1,108 cases attending the E.N.T. department of G.M. and Associated Hospitals, Lucknow. The lateral extensions to pterygomaxillary fossa, cheek and infratemporal fossa are still more uncommon. Friedberg (1940), Erich (1955), Figi (1950), Handousa (1954), Tapia Acufia (1956), and Harma (1958) described such extensions occurring after destruction of lateral wall of nasopharynx and extending towards the pterygomaxillary fossa. The tumour extends towards the cheek winding round the posterior border of the maxilla and creeping towards the infratemporal and temporal fossae deep to the Zygomatic arch. Martin (1954) described an alternative route to the cheek by anterior extension of the tumour to the nasal fossa and then by transmaxillary extension to the cheek destroying the medial and anterolateral wall of the antrum. Hora (1962), however, reported a case with a similar type of tumour in the cheek and pterygomaxillary fossa without any evidence of it in the nasopharynx. Sardana (1965) reported four such cases of cheek extension observed and treated. Samy and Girgis (1965) described three cases of such extensions and advocated the trans-Zygomatic approach to such a tumour during surgical excision. Out of the total series of ninety-two cases of nasopharyngeal fibroma studied during the last 27 years by Mishra and Bhatia (1964), they reported seventeen cases with the tumour extending to the pterygomaxillary fossa, twelve of them showing extension towards the cheek and five to the infratemporal fossa. In spite of extensive literature on the subject there does not appear to be agreement amongst the various authors regarding the ideal line of approach to these cases. This may perhaps be due to the personal experience of each surgeon being limited to only a few cases and therefore everyone stresses one's own approach as the best one. In view of this controversy it is worth while to report some observations and experiences of the authors based on the study and surgical management of seventeen cases of lateral extension treated during the last 27 years in the Gandhi Memorial and Associated Hospitals, Lucknow, India (from 1938 to 1954).