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133388791 AngioFibroma NasoF Juvenile Ppt
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Transcript of 133388791 AngioFibroma NasoF Juvenile Ppt
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AngiofibromaAngiofibroma
NasofaringNasofaring
JuvenilisJuvenilisAngiofibromaAngiofibroma NasofaringNasofaring
JuvenilisJuvenilis
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Angiofibroma NasofaringAngiofibroma Nasofaring
Juvenilis (ANJ)Juvenilis (ANJ)• Tumor jinak yg berasal dari
dinding nasofaring
• Tumor tumbuh ekspansif kesekitarnya, progresif, mudahberdarah perdarahan hebat
dari hidung dan mulut klinis ganas
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ANJ
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ANJ cenderung tumbuh & ekspansi
keluar nasofaring
Anterior ke rongga hidung,
sinus maksila & etmoid, ronggaorbita
Inferior tumor menekan
palatum mole (bombans!", kemeso#orofaring ( obstruksi jln
napas atas"
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$uperior ke intra kranial yaitu%
ke sinus sfenoid, lalu ke fosa
pituitari, menekan sinus ka'ernosus
ke fosa kranii anterior (melalui
lamina kribrosa"
ateral ke fosa infra temporalis
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• )askularisasi tumor terut* dr
cab a* maksilaris interna& a* faringealis asenden
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MakroskopisMakroskopis
• Tumor berbentuk o'al#bulat, berlobus
lobus, kadang bertangkai
• +onsistensi padat kenyal, diliputimukosa
• arna kemerahan, atau merahungu
• -erbatas jelas
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HistopatologiHistopatologi tumor t*d* stroma dgn sel. fibroblas
& sejumlah serat. kolagen, ditemukan
banyak pembuluh darah seperti kapilerberukuran besar tanpa tunika muskularis
/ejala utama epistaksis profus
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Laki >>> wanita
usia 10 -17 th (pubertas,
dekade 2)
jarang > 25 th- bertambahnya usia (> 20-25 th) tumor
mengei! (teoritis)
0,012 dari tumor +epala eher
• Angka kejadian 3%1*000 s*d 3%10*000
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EtiologiEtiologi
4 -elum pasti
4 Teori%
Teori jaringan tempat asal tumor
5ertumbuhan abnormal jar*paraganglionik di sktr bag* akhir a*
maksilaris interna (nutrisi utama"
5ertumbuhan jar* fibrokartilagoembrionik & korpus sfenoid yg tjd
sblm 6kt osifikasi tlg kepala
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5eriostium 'entral ddg posterior
nasofaring tdk bisa mjd tlg ygsemestinya tjd hipertrofi
jaringan akibat peningkatan
hormon pertumbuhan
5ertumbuhan fasia basalis yg
terbentuk dr pertemuanaponeurosis faringeal & fasia
bukofaringeal dekat dasar tlg
kepala
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Teori 7ormonal
/angguan keseimbangan hormonandrogen & estrogen
45emberian estrogen menurunkan
ukuran tumor & mengurangi
kecenderungan perdarahan
45emberian testosteron
meningkatkan ukuran tumor
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sistem pituitari androgenitalsistem pituitari androgenital
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Lokasi
atap nasofaring (plg sering", dinding lateral nasofaring
4 Tumor tumbuh relatif cepat memenuhi nasofaring ke
struktur sekitar
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Anamnesis
o 7idung buntu (uni#bilateral"o 8pistaksis berulang, profus (bisasampai anemi"
o $akit kepala (o*k* blokade sinusparanasalis 'acum sinusheadache"
o 7idung # 6ajah membengkak30392
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• Nasofaringoskopi
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Pemeriksaan KlinisPemeriksaan Klinis
• :*A* massa kemerahan # ungu di hidung• :5 massa di nasofaring
• Tumor ekspansi ke sekitarnya %
mesofaring
massa di mesofaring,palatum mole bombans; rongga orbita protopsis (30312"
sinus maksila maksila membengkak
fosa pterigopalatina mass di pipi (infratemporal" intra kranial (sefalgi"
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RadiologiRadiologi
<oto plain % aters, skull A5#at, basis kranii
Arteriografi
=T $can # >:I
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iagnosisiagnosis" Laki2, usia pubertas
" #$ % hidung buntu, epistaksis beru!ang &pro'us
" em k!inis % tumor naso'aring dgnpermukaan !iin, warna kemerahan * ungu
" +adio!ogis ( .an * /+) massa tumor
di naso'aring (ekstensi ke sekitarnya)
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!taging ANJ!taging ANJ
>enurut $ession (3?93", di re'isi>enurut $ession (3?93", di re'isi
:adko6ski (3??@" %:adko6ski (3??@" %4 $td I % tumor terbatas di nasofaring
4 $td II% tumor meluas ke rongga hidung
&# sinus sfenoid
4 $td III% tumor meluas ke sinus maksila,etmoid, fosa pterigomaksila, fosa
infratemporal, orbita4 $td I) % tumor meluas ke intrakranial
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!taging ANJ!taging ANJ >enurut <ish (3?9", dire'isi oleh Andre6s>enurut <ish (3?9", dire'isi oleh Andre6s
(3?9?"%(3?9?"%4 $td Ia % tumor terbatas di nasofaring &# ka'um nasi4 $td Ib % perluasan kedalam satu#lbh sinus
paranasal4 $td IIa% perluasan minimal kedalam fosa
pterigomaksila4 $td IIb% ke fosa pterigomaksila disertai
penekanan ke depan dinding posterior antrumsinus maksila, ekstensi ke atas erosi tlgorbita
4 $td IIc% perluasan ke fosa pterigomaksila
4 $td III% perluasan ke intrakranial
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"ERAP#"ERAP#$%$% &perasi&perasi (treatment of 'oi'e) (treatment of 'oi'e)
$td Ia % transpalatal
$td Ib, IIa % transpalatal B :
$td IIb% : diperluas dg membelah bibir atas
$td IIc% : diperluas membelah bibir atas C
maksilektomi posterior & medial B embolisasi # ligasi A*+arotis ekst* pra bedah
%% Radiasi * + ormonRadiasi * + ormon untuk $td III, tumor sgt
besar, tumor residif (kecil"7ormon estrogen % Dietilstilbestrol (1 mg#hari, selama . bln" <olliculin (estrogen sintetis"
Tujuan % mengecilkan tumor
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,onto kasus ANJ
=T scan=T scan
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o Insisi mukosa palatum bentuk E
&perasi ekstraksi ANJ&perasi ekstraksi ANJ
dgn pendekatan transpalataldgn pendekatan transpalatal
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o >emisahkan mukosa & otot dari tulang flap mukosa palatum
o <iksasi flap palatum ke anterior
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Tulang palatum durum di potong dgnpahat tampak # teraba tumor
Tumor dipegang dgn tang khusus
tumor di ekstraksi
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ANJ
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5rognosis" .tadium dini baik
" .tadium !anjut (per!uasan ke ronggatengkorak) je!ek