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What is Treatment of choice for Nasopharyngeal carcinoma is - and explain in detail?
(A) (Radiotherapy) (266- Dhingra 5th) (527-29 - Hazarika 3rd)NASOPHARYNGEAL CARCINOMA (NPC)* Irradiation is treatment of choice (266-Dhingra).* Due to close proximity to skull base, surgery has a limited role in NPC. Chemoradiotherapy is the treatment of choice.* Supravoltage therapy (6000 - 7000 rods) chemotherapy (Cisplatin or 5 FU).* Fossa of Rossenmullar is the commonest site of origin of NPC**** Cervical lymphadenopathy (Neck nodes) are most common presentation***.* NPC can cause - Trottler's triad (conductive deafness, ipsilateral temporoparietal neuralgia (cranial nerve V) and palatal paralysis (CN-X))* NPC is most common in CHINA*** Type I (Keratinizing) Type II (Non-Keratinizing) Type III (undifferentiated) squamous cell carcinoma.NASOPHARYNGEAL FIBROMA (JUVENILE NASOPHARYNGEAL FIBROMA)* JNA exclusively affects adolescent males and arises around the sphenopalatine foramen.* Profuse paroxysms, painless, unprovoked and recurrent epistaxis is the most common presentation.* Antral sign or Holman-Miller sign*** - Anterior bowing of the posterior wall of maxillary sinus is pathognomic of angiofibroma.* Biopsy of JNA is contraindicated due to fear of fatal profuse bleeding.* Complete excision of JNA is its treatment of choice** surgical approach is decided by its extranasopharyngeal extension.FISCH - classification is used for Glomus tumour* Brow sign, Aquinosign, "Rising sun" appearance, Phelp's sign is seen in Glomus tumour**** Treatment of choice for Glomus tumour is = Surgery* Most common site of Acostic neuroma (vestibular schwannoma or eight nerve tumour is - C.P. Angle**)* Citelli's angle (Sinodural angle) is situated between the sigmoid sinus and middle fossa dura plate.