Benign neoplasm of the maxillary sinuses. Fibroids in the nose

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Benign nasal tumors can develop from any tissue.

Angiomas

Angiomas ( angioma; Greek angeion- vessel + - ota- ending, denoting a tumor) refer to benign vascular formations located on the wings of the nose between the skin and cartilage tissue. Angioma from blood vessels called hemangioma, often found in various parts of the skin of the body, accounts for 2-3% of all tumors and about 7% of benign neoplasms. Angioma from lymphatic vessels is called lymphangiomas, is rare.

Pathogenesis and pathological anatomy. Hemangiomas are often multiple (angiomatosis). Many hemangiomas lack the capacity for progressive growth and are not true tumors, but congenital ones, resulting from excessive vascular development. Distinguish capillary, cavernous And branchy hemangiomas. The first is a cluster of collapsed or swollen capillaries, the second is a knot of large blood-filled cavities, the third is a tangle of dilated and tortuous vessels of the arterial or venous type.

. Hemangioma of the external nose does not cause any special functional disturbances, except for those cases when it spreads from the wings of the nose to their inner surface. In these cases, nasal breathing is impaired.

In early childhood, hemangiomas grow rapidly. Capillary and cavernous hemangiomas have infiltrating growth, but never metastasize. Bleeding from hemangioma does not pose a significant danger due to the low blood pressure in their wide vascular cavities.

Diagnosis. External hemangiomas are easily recognized by their shape, purple-pink or bluish color and soft consistency. Hemangiomas of the nose are often combined with hemangiomas of the corresponding half of the face.

Treatment depends on the type of hemangioma. Small capillary hemangiomas are removed using electrocoagulation, a surgical laser, or a cryoapplicator. Large capillary or cavernous hemangiomas are removed surgically or by infiltrating them with coagulating solutions, such as uretanquinine. Treatment for hemangioma usually begins in early childhood.

Dermoid cyst of the base of the nose

A dermoid cyst of the base of the nose is a solitary tumor of embryonic origin located in the midline in the upper part of the dorsum of the nose.

Pathological anatomy. This is a sac-like formation of a round shape, the size of a pea to a pigeon egg. The wall of the cyst consists of connective tissue, covered from the inside with epidermal-type integumentary epithelium containing fat glands and hair follicles.

Symptoms and clinical course. In most cases, the cyst does not cause any subjective distress to the patient, with the exception of an existing cosmetic defect. Sometimes the cyst becomes infected, filled with pus with the formation of a fistula, through which pus, liquid fatty masses and even embryonic inclusions in the form of hair and cartilage tissue are released. As a rule, the resulting fistula does not close on its own; may close for a while and then recur.

Treatment only surgical with complete excision of the cystic sac. The occurrence of relapses after surgery is due to the growth of the remnants of the cyst wall.

Nasal papilloma

Nasal papilloma is a tumor that develops from squamous or transitional epithelium and protrudes on its surface in the form of a papilla.

Etiology. In most cases, this tumor is viral in nature.

Pathological anatomy. This tumor is a limited (1-2 cm) dense or soft formation on a stalk, less often on a broad base. It is found on the skin of the nose, the mucous membrane of its cavity, in the paranasal sinuses, pharynx, vocal folds, bladder, etc. Multiple papillomas are called papillomatosis. The surface of the papilloma is uneven, reminiscent of cauliflower or cockscomb. Skin papilloma has a different color - from white to dirty brown.

Clinical course. Located on the skin of the face and neck, papilloma causes one or another cosmetic defect. When localized on the skin of the vestibule of the nose, it can cause disruption of nasal breathing. In some cases, especially with chronic trauma, papilloma may undergo malignancy.

Treatment surgical - deep excision, cryodestruction, use of a surgical laser.

Bleeding nasal septum polyp

A bleeding polyp of the nasal septum is an angiofibromatous tumor located on one side of the nasal septum, most often in the area of ​​the anterior venous-arterial plexus (locus Kisselbachii), less often on the inferior or middle turbinate or on the lateral wall of the nasal cavity.

Etiopathogenesis. Etiology unknown. Since this disease occurs more often in women, it is assumed to be related to the endocrine nature of the female sex. There are other theories, for example traumatic, inflammatory, oncological.

Pathological anatomy. The polyp is a round tumor, ranging in size from a small pea to a large cherry, dark red or bluish in color, papillary or mushroom-shaped, pedunculated, and bleeding easily.

Symptoms and clinical course. Frequent unilateral nosebleeds and progressive unilateral nasal breathing disorder. The tumor is detected by endoscopy. When palpated with a probe it bleeds. When lubricated with adrenaline solution, the tumor does not shrink.

Diagnostics does not cause any difficulties; The diagnosis is established on the basis of frequent bleeding repeated from the same half of the nose and rhinoscopy data.

Differential diagnosis. In doubtful cases, histological examination of the removed tumor is used, differentiating it from lupus, tuberculosis, scleroma and cancer.

Treatment. Excision of the tumor with the underlying perichondrium. If localized on the nasal concha, the tumor is removed with resection of the concha.

Osteoma of the nasal cavity

Osteoma of the nasal cavity is a tumor that develops from bone tissue. Occurrence in the nasal cavity is a rare phenomenon; more often this tumor primarily develops in the frontal and maxillary sinuses, in the ethmoid bone and from here penetrates into the nasal cavity. Most often this tumor occurs in people young. Sometimes combined with chondroma.

Symptoms, clinical course determined by the size of the tumor, the speed and direction of its growth. Difficulty in nasal breathing increases, usually on one side; on the same side there is hyposmia, mucopurulent discharge, and often trigeminal neuralgia. Anterior rhinoscopy, usually in the middle nasal passage, reveals a dense swelling covered with normal or hyperemic mucous membrane. The mucous membrane over the osteoma becomes thinner and ulcerated over time, which causes frequent nosebleeds. The tumor expands and compresses the surrounding tissues, causing various disorders (lacrimation, neuralgic pain, secondary sinusitis, exophthalmos, etc.).

Diagnostics. X-ray examination is of decisive importance, in which a bone formation with smooth contours is detected in the nasal cavity.

Treatment surgical with removal of the underlying bone tissue.

Neuroma of the nose

Nasal neuroma is a tumor that develops from nervous tissue; occurs extremely rarely. Neuromas are divided into gliomas- congenital tumors developing from neuroglia, and neuroblastoma, characterized by a malignant course.

Gliomas are detected in early childhood and manifest as swelling in the root of the nose, ranging in size from a pea to a cherry. The size of the tumor increases when straining, when the child coughs or cries. The tumor is dense to the touch, adherent to the skin and underlying tissue.

Neuroblastoma It is detected only when the patient begins to have nosebleeds, difficulty in nasal breathing, headaches, and sometimes exophthalmos.

During rhinoscopy, a reddish-gray fleshy tumor is found in the nasal cavity, filling half of the nasal cavity, which bleeds easily when touched with a probe. An external sign of a tumor is expansion of the root of the nose, smoothing of the area of ​​the inner corner of the eye and the appearance of swelling here, in advanced cases - exophthalmos and amaurosis. Neuroblastoma does not metastasize.

Forecast in the initial stages of tumor development, careful; in cases of tumor growth into the orbit, ethmoid labyrinth, anterior cranial fossa - very serious.

Treatment complex: surgery in combination with radiation therapy. The tumor often recurs.

Otorhinolaryngology. IN AND. Babiyak, M.I. Govorun, Ya.A. Nakatis, A.N. Pashchinin

Tumor diseases of the nose- these are diseases the occurrence of which is caused by the transformation of normal cells of tissues and organs into tumor cells. Tumors can be malignant or benign. In medical practice, benign tumor formations of the nose are quite common.

Nasal tumors include:

• fibroids
• papillomas
• angiomas and angiofibromas
• osteomas
• nevi
• warts
• neuromas
• pigment tumors, etc.

Typical signs of nasal tumors are:

• • • difficulty breathing through that side of the nose
    • which is affected by a tumor disease
    • hyposmia
    • anosmia
    • in some cases minor bleeding occurs

If the disease is not treated, then at a late stage it can lead to deformation of the facial skeleton, headaches, visual disturbances, etc. Diagnosis is carried out using endoscopy, probing, palpation, and histological examination of a piece of tumor.

Papillomas are most often localized in the vestibule of the nose. Papilloma looks like a small bush or a single papilla located on a narrow base. This tumor grows slowly and relapses may occur after its removal. Therefore, removal of papilloma must be radical. After tumor removal, electrocoagulation or laser destruction of the wound surface is performed.

Removal of nasal fibroids

Fibroma of the nose- This is enough rare disease. Most often, fibroma is located in the vestibule of the nose or nasopharynx. The first signs of fibroma are one-sided nasal congestion, which later turns into a complete absence of nasal breathing. If the tumor is not removed in a timely manner, its growth causes changes in the shape of the upper jaw, cheek, and nasal septum. The patient also experiences bleeding, which becomes stronger and more frequent over time. The first signs of fibroma are nasal congestion; if treatment is not started in a timely manner, then deformation of the cheek, palate and upper jaw occurs. Treatment of fibroids should only be surgical. If the tumor is small, it is removed using curved scissors or special forceps.

Removal of nasal osteoma

Osteomas of the nose most often develop at the age of 15-25 years. Such tumors grow quite slowly and are located mainly in the ethmoid bone or the walls of the frontal sinuses. In some cases, osteomas can cause persistent headaches and various brain disorders. Osteomas can only be treated surgically. Even if the osteoma is of average size and does not cause severe symptoms, it must still be completely removed.

Removal of nasal angioma

Nasal angiomas are benign formations of the nose that arise as a result of intrauterine disorders of the vascular system. Quite often, angiomas are multiple - this disease is called angiomatosis. Angioma can be capillary, cavernous or branched. A capillary angioma is a collection of swollen capillaries, a cavernous angioma is a tumor formed from large blood-filled cavities, and a branched angioma is a tangle of dilated or tortuous veins or arteries. Angiomas in most cases do not cause any functional impairment. Only when the angioma is located on the wings of the nose or on their inner surface can nasal breathing be disrupted. Angiomas are diagnosed by examination. They are easily recognized by their shape, bluish or purple-pink color, and soft consistency. Angiomas of the nose are often combined with angiomas of the accompanying half of the face. Treatment for angioma depends on its type. Capillary angiomas are destroyed by electrocoagulation, cryodestruction or laser. Larger capillary or cavernous angiomas are removed surgically.

Removal of nasal angiofibroma

Angiofibromas of the nose can develop in various parts of the nasopharynx. Angiofibroma can be located in the nasal cavity or paranasal sinuses, so it can sometimes be confused with an angioma or fibroma. This fact is very important to take into account when diagnosing. When carrying out differential diagnosis, it should be taken into account that angiofibroma is not just a fibroma rich in blood vessels or an angioma with a developed stroma, but a two-component tumor, in which both components equally have tumor properties. Treatment of angiofibromas is exclusively surgical, but when removing it, it must be taken into account that this tumor is prone to invasion and recurrence.

Nasal neuroma removal

Neuroma is a benign tumor that develops from nervous tissue. Neuromas as such are further subdivided into gliomas and neuroblastomas. Gliomas are congenital neuromas and are benign, while neuroblastomas can appear at any age and are malignant. Glioma can be detected at an early age and appears as a swelling in the nose. The size of the tumor increases when the child cries or coughs. The glioma is dense to the touch. Neuroblastoma is detected when the patient begins bleeding, difficulty in nasal breathing, and headaches, since in the initial stage it grows very slowly. Having reached a certain size, the tumor begins to grow very quickly and penetrates the surrounding tissue. External signs are enlargement of the root of the nose, swelling in the area of ​​the inner corner of the eye. On rhinoscopy, the tumor appears as a reddish-gray formation that bleeds even when touched lightly with a probe. Neuroma The nose can only be treated with surgery and, in some cases, combined with radiation therapy. After removal, the tumor tends to recur.

Removal of pigmented tumors of the nose

Pigmented tumors(nevi) occur in more than 90% of the population. They appear both from birth and throughout life. A pigmented tumor is a flat or slightly raised nodule with clearly defined boundaries. The color of pigmented tumors can vary from brown to black. During life, pigmented tumors can turn into melanoma, one of the most malignant tumors. Melanoma in the vast majority of cases develops precisely at the site of the skin nevus. The transition from a pigmented tumor to melanoma is facilitated by trauma, hormonal changes in the body, increased level radiation, excess ultraviolet radiation, etc. Today, pigmented tumors can be removed using various methods and this is recommended for the purpose of preventing melanoma.

Removal of benign nasal tumors at the Tauras-Med clinic

In our medical center "Tauras-Med" they remove absolutely any type of benign formations of the nose. We employ experienced doctors who, using the most modern equipment, quickly and painlessly solve any problems related to diseases of the ENT organs. If you need to remove a benign formation of the nose, then you should call our clinic and the consultant will make an appointment with a specialist on the most suitable day for you.

Nasopharyngeal fibroma is a fibrous tumor of dense consistency, characterized by significant bleeding, which is why it is called angiofibroma. This tumor has been known since the time of Hippocrates, who proposed the so-called transnasomedial approach by bifurcating the nasal pyramid to remove this tumor.

The place of origin of the tumor is most often the fornix of the nasopharynx, its pharyngeal-basal fascia (basilar type of tumor, according to A. G. Likhachev, 1954). Research recent years XX century showed the possibility of the development of juvenile fibromas of the nasopharynx from the pterygomaxillary and sphenoid-ethmoid areas.

What causes nasopharyngeal fibroma?

The etiology of this disease is virtually unknown. Existing “theories” of disembryogenesis and endocrine dysfunction have not completely solved the problem. The “endocrine theory” is based on the fact that the tumor develops simultaneously with the development of secondary sexual characteristics and the period of its development ends with the completion of puberty. It has also been noted that with nasopharyngeal fibroma, disturbances in the secretion of 17-ketosteroids and the ratio of androsterone and testosterone are observed.

Pathological anatomy of nasopharyngeal fibroma

Nasopharyngeal fibroma is a very dense tumor sitting on a wide base, closely fused to the periosteum. The strength of the fusion with the periosteum is so great that in other cases, when a tumor is removed by tearing it out, fragments of the underlying bone are also removed along with it. The surface of the tumor is covered with smooth papillary formations of pale pink or reddish light, depending on the degree of vascularization of the tumor. The density of the tumor is determined by its fibrous nature. The tumor has a pronounced extensive growth, dislocating and destroying all tissues and filling all neighboring cavities located along this path (choanae, nasal cavity, orbit, sphenoid sinus, lower parts of the nasopharynx, paranasal sinuses, zygomatic and temporal fossae, etc.) . As the tumor spreads anteriorly, it fills the nasal passages, destroying the vomer, nasal septum, superior and middle turbinates, penetrating the cells of the ethmoidal labyrinth, the frontal and maxillary sinuses, deforming the pyramid of the nose and disturbing the appearance of the face. When spreading posteriorly and downward, the tumor destroys the anterior wall of the sphenoid sinus and penetrates it, sometimes reaching the pituitary gland, spreading downward, often reaching the soft palate and oropharynx.

Thus, due to extensive growth and destructive effects on surrounding organs and tissues, nasopharyngeal fibroma can be clinically classified as “malignant”, but it does not metastasize and is histologically classified as benign tumors. Morphologically, it consists of varying severity of choroid plexuses and connective tissue stroma, consisting of collagen fibers and fibroblasts. The tumor is covered with epithelium, which in the nasopharynx has the character of a single-layer nasal epithelium, and in the nasal cavity - a cylindrical ciliated epithelium - a fact explained by the fact that the tumor arises in the transition zone squamous epithelium into a cylindrical one. The vascular content of the tumor, especially with the venous plexuses, is very large. Veins, by resorption of their walls, merge with each other, forming entire “lakes” of blood with very fragile “shores”, the trauma of which (for example, when sneezing) or spontaneously cause profuse, difficult to stop nasal and pharyngeal bleeding. With the reverse development of the tumor in the vascular endothelium, phenomena of necrobiosis and hyalinization occur, and in the stroma - phenomena of an inflammatory nature. As a result, non-viable tumor tissue undergoes resorption, the tumor sharply shrinks and is replaced by scar tissue.

Symptoms of nasopharyngeal fibroma

Symptoms of nasopharyngeal fibroma develop slowly and are divided into subjective and objective. In the initial stages of tumor development, there is a gradually increasing difficulty in nasal breathing, sometimes causeless headaches and dull pain in the base of the nose, high mental and physical fatigue, due to which children begin to lag behind in mastering the school curriculum, in physical development, often suffer from colds. Nasal discharge is mucopurulent in nature. Complaints appear, first of minor ones, then of ever-increasing nosebleeds, due to which the child develops anemia. Subsequently, the tumor fills the nasal cavity, causing increasing difficulty in nasal breathing, up to its complete absence. The child's mouth is constantly open, his speech becomes nasal (rhinolalia operta), obstruction of the auditory tube causes hearing loss, and at the same time there is a loss of smell and a decrease in taste sensitivity. When the tumor comes into contact with the soft palate, patients complain of impaired swallowing function and frequent choking. Compression of sensitive nerve trunks causes neuralgic eye and facial pain.

During an objective examination, the doctor sees a pale child or young man with a constantly open mouth, blue stains under the eyes and a swollen base of the nose. In the nasal passages there is mucopurulent discharge, which the patient cannot remove by blowing his nose due to obstruction of the choanae (expiratory valve) by the tumor. After removing these secretions, a thickened, hyperemic mucous membrane and enlarged bluish-red nasal turbinates appear. After lubricating the mucous membrane of the nose with adrenaline and contracting the turbinates, the tumor itself becomes visible in the nasal passages in the form of a sedentary, smooth, grayish-pink or reddish formation that bleeds heavily when touched with a sharp instrument.

Often, a tumor filling the nasal canopy is combined with one or more common secondary nasal polyps.

With posterior rhinoscopy, the typical picture, in which the choanae, vomer and even the posterior ends of the nasal conchae are clearly visible, is not determined. Instead, a massive bluish-red tumor is determined in the nasopharynx, completely filling it and sharply different in appearance from banal adenoid vegetations. A digital examination of the nasopharynx, which should be carried out carefully so as not to cause bleeding, reveals a dense, immobile solitary tumor.

Associated objective symptoms may include lacrimation, exophthalmos, and dilatation of the nasal root. With the bilateral manifestation of these signs, the patient’s face acquires a peculiar appearance, which is called foreign literature"frog face" Oropharyngoscopy may reveal bulging of the soft palate due to the presence of a tumor in the middle parts of the pharynx.

An unremoved tumor grows to enormous sizes, filling the entire space of the nasal cavity, the orbit and, going beyond their limits, causing severe functional and cosmetic disorders. The most serious complication is the tumor perforating the cribriform plate and penetrating into the anterior cranial fossa. Initial signs This complication is manifested by a syndrome of increased intracranial pressure (drowsiness, nausea, vomiting, incurable headache), then signs of retrobulbar syndrome (loss of visual fields, ophthalmoplegia, amaurosis) appear. Frequent hemorrhages and unbearable headaches, vomiting and food aversion lead the patient to a severe general condition, cachexia, anemia, not much different from the condition in the presence of a malignant tumor. Often such advanced conditions, which occurred in former times in less civilized areas and countries, were complicated by meningitis and meningoencephalitis, inevitably leading to the death of patients.

Fibromyxoma, or choanal polyp

Fibromyxoma, or choanal polyp, originates in the choanal or ethmoidosphenoidal region. Externally, this benign tumor looks like a pedunculated polyp, which is easily removed without bleeding using a special hook. Compared to mucous polyps of the nasal cavity, the consistency of the choanal polyp is more dense. It grows towards the pharynx and nasal cavity. “Old” polyps become denser, acquire a reddish color and often simulate nasopharyngeal fibroma, however, unlike it, they do not bleed and do not grow extensively.

Treatment is surgical.

Sinochoanal polyp

The sinochoanal polyp is actually a manifestation of polypous sinusitis, since it comes from the maxillary sinus and prolapses through the choana into the nasopharynx. Less commonly, this “tumor” comes from the sphenoid sinus. Externally, the sinochoanal polyp can be compared to the tongue of a bell, which hangs into the nasopharynx and sometimes reaches the oropharynx, located between its posterior wall and the soft palate. In structure, this polyp is a pseudocystic formation of a whitish-gray color of an ovoid shape, which completely fills the nasopharynx and causes difficulty in nasal breathing and tubular hearing impairment.

Treatment is surgical.

Nasopharyngeal cysts

Nasopharyngeal cysts arise either as a result of blockage of the duct of the mucous gland (retention cyst) or the pharyngeal pouch of Thornwald. Nasopharyngeal cysts are rare tumors characterized by long-term evolution and manifested by disturbances in nasal breathing and hearing due to blockage of the nasopharyngeal mouth of the auditory tube. Posterior rhinoscopy reveals a smooth, round, gray tumor with elastic consistency. The cyst is removed using an adenotomy.

Dermoid cysts of the nasopharynx

Dermoid cysts of the nasopharynx are very rare congenital benign tumors, most often observed in infants. They develop very slowly and produce minimal dysfunction, mainly a dry reflex cough and some discomfort when swallowing. As a rule, the stalk of this “polyp” comes from the lateral wall of the nasopharynx around the nasopharyngeal opening of the auditory tube and often reaches the pharyngeal-epiglottic fold. It is not detected during conventional pharyngoscopy, but with a gag reflex it can appear in the oropharynx in the form of an oblong solitary polyp of a whitish-gray color with a smooth surface. Its surface has a leathery appearance with papillae, sweat and fat glands, as well as hairs. Under this layer there is tissue penetrated by venous vessels. In the center of the tumor, a core is formed, formed by dense connective tissue, sometimes containing fragments of bone or cartilage tissue, as well as striated muscle fibers (a typical “set” of tissue for embryonal tumors). Treatment consists of cutting the pedicle of the cyst. Subsequently, dermoid cysts of the nasopharynx become sclerotic and after some time (months to several years) resolve.

Papillomas and lipomas of the pharynx

Papillomas and lipomas are benign tumors that are rarely found in the upper parts of the pharynx and are visually very difficult to distinguish from common adenoid tissue. The final diagnosis is made by histological examination. They are removed using an adenotom.

Skull base meningoceles can sometimes occur in the nasopharynx and most often in children. It differs from other benign tumors in that it enlarges when the child cries. Such “tumors” cannot be treated, since they are accompanied by other severe anomalies in the development of the skull and other organs, usually incompatible with life.

Benign plasmacytoma

Benign plasmacytoma originates from reticuloendothelial tissue and occurs most often in the bone marrow; more than 80% of extramedullary tumors of this type are localized in the upper respiratory tract. By appearance resemble polypoid formations of a grayish or pinkish-violet color, do not ulcerate. The diagnosis is based on histological examination. Solitary plasmoditoma can be either benign or malignant. Benign plasmacytoma is rare and should not be confused with simple granuloma, which consists of large quantity plasma cells. Malignant plasmacytoma is excluded by the fact that X-ray does not reveal bone lesions, sternal puncture does not detect pathological changes in the bone marrow, there are no myeloma cells, Bence Jones protein is not detected in the urine, and, finally, when the tumor is removed, no relapse is observed. Protein fractions of blood are also studied, which in benign tumors persist for normal level. Most plasmacytomas are malignant tumors either of extramedullary localization or of the nature of “diffuse” myeloma, which constitutes the essence of multiple myeloma.

Benign plasmacytomas, if they cause certain functional disorders, depending on their size, are removed by various surgical methods, after which they do not recur. Malignant plasmacytomas cannot be treated surgically. Non-operative antitumor methods are used for them.

Diagnosis of nasopharyngeal fibroma

The diagnosis of nasopharyngeal fibroma is established mainly by the clinical picture, the fact of the occurrence of nasopharyngeal fibroma in males in childhood and adolescence. The extent of the tumor is determined using X-ray or MRI or CT examination, as well as using angiography.

Differential diagnosis of nasopharyngeal fibroma becomes essential, since treatment tactics and, possibly, prognosis depend on its result. Nasopharyngeal fibroma is differentiated from adenoids, cysts, fibromyxoma, cancer and sarcoma of the nasopharynx. Main hallmark fibroids is their early and frequent bleeding, which is not observed at all with all other benign tumors of this localization, and with malignant tumors bleeding is observed only at their advanced clinical and morphological stage.

Treatment of nasopharyngeal fibroma

Numerous attempts to use non-operative treatment methods (physiotherapeutic, sclerosing, hormonal) did not provide a radical cure; the only method that often resulted in complete recovery, especially in combination with non-surgical methods, was surgery. However, the classical method of tumor extraction, used in earlier times by tearing it off from its attachment site using special forceps via oral access, was not justified due to the impossibility of removing the fibrous base of the tumor, firmly fused to the periosteum (hence the inevitable relapses) and severe, difficult to stop intraoperative bleeding. To facilitate access to the tumor, the French rhinosurgeon Nelaton proposed splitting the soft and hard palate. Other approaches to the tumor have also been developed, for example, the use of a rhinotomy method using Moore's para-lateral-nasal incision or Denker's sublabial rhinotomy.

Denker's operation is a preliminary surgical intervention to create wide access to the internal pathological formations of the nasal cavity and, in particular, to the maxillary sinus, the middle and posterior parts of the nasal cavity and the base of the skull (nasopharynx, sphenoid sinus). In advanced cases, when the tumor grows into the zygomatic region, paranasal sinuses, orbit or retromaxillary region, it is removed after creating preliminary approaches. According to A.G. Likhachev (1939), the most advantageous access to the tumor is the transmaxillary one according to Denker. But in some cases, depending on the histological characteristics and extent of the tumor, the use of radiation therapy leads to a delay in tumor growth, its reduction and compaction, which helps reduce intraoperative bleeding and facilitates its surgical removal. The same effect is achieved by infiltrating the tumor with 96% ethyl alcohol. In some cases, surgery is performed several times until puberty is completed, when relapses stop, the tumor stops developing and develops backwards.

Surgical intervention requires careful preoperative preparation (improving general condition body, normalization of blood counts, vitamin supplementation, prescription of calcium supplements to strengthen the vascular wall, measures to increase hemostatic parameters). Preparation for surgery should include the possibility of carrying out resuscitation measures, blood transfusions and blood substitutes during the operation. Surgery is performed under intratracheal anesthesia. In the postoperative period, the same measures are carried out as during the preoperative preparation of the patient.

Non-operative treatment methods as independent means do not always provide positive result; It is advisable to carry them out as preoperative preparation or as an attempt at non-operative treatment.

For small tumors, diathermocoagulation can be used using an endonasal approach in people 18-20 years old with the expectation that they will soon complete puberty and will no longer experience a relapse. At the same age, diathermy can be used for minor postoperative relapses.

Radiation treatment is indicated mainly as a protective measure, since fibromatous tissue is X-ray insensitive, but it stabilizes the growth of young cells and new choroid plexuses that become obliterated, thereby limiting access nutrients to the tumor and its growth slows down. Typically, the course of treatment lasts for 3-4 weeks with a total dose of 1500 to 3000 rubles.

Treatment with radioactive elements introduced into the tumor is currently practically not used due to possible secondary complications (atrophy of the mucous membrane of the nose and nasopharynx, necrotizing ethmoiditis, perforation of the palate, etc.). Currently, radium and cobalt are replaced by radon, which is placed in gold capsules. The latter are implanted into the tumor at a distance of 1 cm from each other in an amount of 5-6. The procedure can be repeated after a month; this method does not cause such serious complications as with the application of radium or cobalt.

Main hormonal agent in the treatment of nasopharyngeal fibroids is testosterone, which has androgenic, antitumor and anabolic effects. It regulates the development of male genital organs and secondary sexual characteristics, accelerates puberty in males, and also performs a number of other important biological functions in developing organism. It is used in various dosage forms(capsules, tablets, intramuscular and subcutaneous implants, oil solutions of individual esters or their combinations). For nasopharyngeal fibroma, use 25 to 50 mg/week of the drug for 5-6 weeks. Treatment is carried out under the control of the content of 17-ketosteroids in the urine - normally, the excretion of 17-ketosteroids in men averages (12.83±0.8) mg/day (from 6.6 to 23.4 mg/day), in women - (10.61±0.66) mg/day (6.4-18.02 mg/day) and can be repeated with normal content of this excretion in the urine. An overdose of testosterone can lead to testicular atrophy, early appearance of secondary sexual characteristics in children, disorders of osteonesis and psyche, as well as an increase in the content of 17-ketosteroids in the urine.

Symptoms of nasal fibroma

The disease is rare. The tumor is most often located in the area of ​​the external nose, the vestibule of the nose, or in the nasopharynx.

Nasopharyngeal fibroma almost always develops in boys 10-13 years old and is benign. From this age it grows rapidly, destroying adjacent organs and tissues. Located in the nasopharynx, it grows into the nasal cavity, paranasal sinuses, orbit, and cranial cavity, leading to the development of severe complications. At the age of about 24-25 years, it begins to decrease in size and disappears. The first sign of nasopharyngeal fibroma is the appearance of nasal congestion on one side, which turns into a complete lack of breathing on both sides. In the absence of timely treatment, further growth of the tumor causes protrusion of the eye, changes in the shape of the cheek, upper jaw, palate, and curvature of the nasal septum. From the very beginning of the disease, the patient is bothered by nosebleeds, which become more frequent and abundant over time. Bleeding causes pallor of the patient’s skin and mucous membranes, complaints of weakness, and dizziness.

The disease can be complicated by the development of meningitis, blindness, anemia, surgery dangerous due to the development of heavy bleeding.

Treatment of nasal fibroma

Treatment is surgical. Before removing the tumor, alcohol is injected into its tissue to harden it and prevent possible bleeding. Small fibroids are removed through the nose or mouth using special forceps or curved scissors. Large tumors are removed through an access created in the upper jaw. Sometimes, before surgery, X-ray irradiation of the tumor is performed, which causes its size to shrink and makes it easier to remove. Radiation treatment alone is ineffective. The operation is performed under inhalation anesthesia.

Ozena or foul runny nose: symptoms, treatment

Ozena or fetid runny nose is a chronic disease of the nasal cavity with a sharp atrophy of the mucous membrane, the formation of thick secretions that shrink into fetid crusts.

Injury to the nasopharynx: symptoms, treatment

Injuries to the nasopharynx result in nasal and pharyngeal bleeding, impaired nasal breathing due to blockage of the nasal passages by blood clots and damaged tissues, swallowing disorders due to damage to soft tissues and pain, and closed-type nasal sounds.