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Assisted resection of lateral extension of juvenile nasopharyngeal angiofibroma using a sphenopalatine fossa dissector

  • A Mishra (a1)

Juvenile nasopharyngeal angiofibroma often attaches firmly to the adjoining bony region around the sphenopalatine foramina–sphenopalatine fossa–pterygomaxillary fissure. This can result in hourglass-shaped constriction and predispose to incomplete resection (residual disease) with a transpalatal approach. This paper describes attempts to address this ‘inaccessible’ area with a novel instrument, used since 2012.


Measurements of the sphenopalatine foramen, nasal septum, posterior nasopharyngeal wall and hard palate were undertaken in 20 skulls and 10 computed tomography scans (lateral extension). A device was designed (in terms of angulation and length) following several trials with malleable wire. A search of patents was also undertaken. Recurrence rates were compared in cases of device use and non-use.


The novelty of the sphenopalatine fossa dissector was established and the device was patented. This device has significantly improved our 17.59 per cent recurrence rate of the past 4 decades; of 63 cases over 3 years, there were only 3 recurrences and 2 residual disease cases. Findings of our previous studies with or without the device are compared.


Existing evidence supports the incorporation of this inexpensive instrument in the armamentarium for resecting lateral extension of juvenile nasopharyngeal angiofibroma during a transpalatal approach.

Corresponding author
Author for correspondence: Dr Anupam Mishra, A-1/19, sector H, Aliganj, Lucknow, Uttar Pradesh, India E-mail:
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Dr A Mishra takes responsibility for the integrity of the content of the paper

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1Mishra, A, Mishra, SC. Time trends in recurrence of juvenile nasopharyngeal angiofibroma: experience of the past 4 decades. Am J Otolaryngol 2016;37:265–71
2Chew, CT. Nasopharynx (the postnasal space). In: Kerr, AG, Groves, J, eds. Scott-Brown's Otolaryngology, Volume IV: Rhinology, 5th edn. London: Butterworth, 1987
3Mishra, A, Mishra, SC. Changing trends in the incidence of juvenile nasopharyngeal angiofibroma: seven decades of experience at King George's Medical University, Lucknow, India. J Laryngol Otol 2016;130:363–8
4Mishra, A, Mishra, SC, Verma, V, Singh, HP, Kumar, S, Tripathi, AM et al. In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma. J Laryngol Otol 2016;130:462–73
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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