Gestão de via aérea em pacientes com nasoangiofibroma juvenil
##plugins.themes.bootstrap3.article.sidebar##
Publicado
May 20, 2025
##plugins.themes.bootstrap3.article.main##
Resumo
Objetivo: Realizar uma revisão narrativa sobre a gestão da VA em pacientes com diagnóstico de NAJ, explorando as estratégias de manejo que visam minimizar os riscos e melhorar o prognóstico desses pacientes. Revisão bibliográfica: O NAJ é um tumor vascular raro, frequentemente associado a elevada morbimortalidade, devido a sua localização anatômica e seu padrão de crescimento localmente destrutivo, e cujo tratamento de escolha é a cirurgia. Representa um desafio especialmente em casos em que o tumor se expande para além do palato mole, em que pode ocorrer obstrução das VAs e tornar a intubação traqueal (IT) potencialmente complexa. Considerações finais: Apesar de raro, o acometimento da VA pelo tumor que dificulta seu acesso, pode ser clinicamente desafiador e requer um planejamento anestésico perioperatório rigoroso, a fim de mitigar riscos e assegurar a perviedade da VA para prosseguir com o tratamento cirúrgico. Mesmo diante da evolução das técnicas e equipamentos anestésicos, o manejo de casos complexos com potencial de dificuldade de acesso à VA ainda exige cuidado e mais pesquisas para otimizar os protocolos de gerenciamento e reduzir a morbimortalidade associada a essa condição rara.
##plugins.themes.bootstrap3.article.details##
Como Citar
GomesM. T., & MendonçaF. T. (2025). Gestão de via aérea em pacientes com nasoangiofibroma juvenil. Revista Eletrônica Acervo Saúde, 25(5), e19952. https://doi.org/10.25248/reas.e19952.2025
Seção
Revisão Bibliográfica
Copyright © | Todos os direitos reservados.
A revista detém os direitos autorais exclusivos de publicação deste artigo nos termos da lei 9610/98.
Reprodução parcial
É livre o uso de partes do texto, figuras e questionário do artigo, sendo obrigatória a citação dos autores e revista.
Reprodução total
É expressamente proibida, devendo ser autorizada pela revista.
Referências
1. ACEVEDO JFO, et a. Tratamiento quirúrgico del angiofibroma nasofaríngeo juvenil en pacientes pediátricos. Acta Otorrinolaringológica Española, 2019; 70 (5).
2. BAKSHI SS, BHATTACHARJEE S. Juvenile Nasopharyngeal Angiofibroma. Journal of Pediatric Hematology/Oncology, 2016;38(6):491-2.
3. BALDASSARI CM, et al. Expert Consensus Statement: Pediatric Drug-Induced Sleep Endoscopy. Otolaryngology Head & Neck Surgery, 2021; 165 (4): 578-591.
4. BHANANKER SM, et al. Anesthesia-related cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry. Anesthesia & Analgesia, 2007.
5. BOGHANI Z, et al. Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic-assisted, and open resection in 1047 cases. Laryngoscope, 2013;123(4):859–69.
6. CANGIANI LH,et al. Uso de videolaringoscópio para intubação traqueal em paciente com massa tumoral na cavidade oral: relato de caso. Brazilian Journal of Anesthesiology, 2020;70(4):434-439.
7. CHIKOTI T, et al. Juvenile Nasopharyngeal Angiofibroma Presenting with Acute Airway Obstruction. Case Reports in Otolaryngology, 2016.
8. DISMA N, et al. Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines. British Journal of Anaesthesia, 2024; 132(1):124 - 144.
9. FELIPPU AWD, et al. Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases. International Archives of Otorhinolaryngology, 2024; 28 (3), p. e432–e439.
10. FIADJOE JE, et al. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. The Lancet Respiratory Medicine, 2016; 4 (1).
11. GIBSON AC, et al. The Impact of Preoperative Flexible Fiberoptic Laryngoscopy on Anesthesia Intubation Plans. Ear, Nose & Throat Journal . 2024;0(0).
12. HACKMAN T, et al. Juvenile nasopharyngeal angiofibroma: The expanded endonasal approach. American Journal of Rhinology & Allergy. 2009;23(01):95–99.
13. HEIDEGGER T. Difficult airway management. The New England Journal of Medicine, 2021;384:1836–1847.
14. HUANG AS, et al. Focused review on management of the difficult paediatric airway. Indian Journal of Anaesthesia, 2019;63(6):428-436.
15. HUANG Y, et al. Surgical management of juvenile nasopharyngeal angiofibroma: analysis of 162 cases from 1995 to 2012. Laryngoscope. 2014;124(8):1942–6.
16. HUMPHREYS S, et al. Troca ventilatória transnasal umidificada por insuflação rápida (THRIVE) em crianças: um ensaio clínico randomizado. Brazilian Journal of Anaesthesiology, 2017;118:232–8.
17. ISELI TA, et al. Outcomes of intubation in difficult airways due to head and neck pathology. Ear Nose & Throat Journal, 2012;91:E1–E5.
18. JAGANNATHAN N, et al. Airway management for pediatric anesthesia. In HAGBERG CA, SUN LS (Ed.), Uptodate, 2024.
19. JAGANNATHAN N, BURJEK N. Troca ventilatória transnasal umidificada por insuflação rápida (THRIVE) em crianças: Um passo à frente na oxigenação apneica, mudança de paradigma na ventilação ou ambos? Brazilian Journal of Anaesthesiology, 2017;118:150–2.
20. JIMENEZ N, et al. An update on pediatric anesthesia liability: a closed claims analysis. Anesthesia & Analgesia, 2007; 104 (1).
21. KAMIYAMA K, et al. Perioperative airway management of a 16‐year‐old boy with progressive airway
obstruction due to juvenile nasopharyngeal angiofibroma. Clinical Case Reports, 2017; 5(8).
22. KRISHNA SG, et al. Management of the Difficult Airway in the Pediatric Patient. Journal of Pediatric Intensive Care, 2018;7(3):115-125.
23. LAO WP, et al. Combined endoscopic and transoral resection of a high-staged juvenile nasopharyngeal angiofibroma: A pictorial essay. Head & Neck, 2021;43(2):719-724.
24. LEWIS SR, et al. Videolaringoscopia versus laringoscopia direta para pacientes adultos que necessitam de intubação traqueal: uma revisão sistemática Cochrane. Brazilian Journal of Anaesthesiology, 2017.
25. LIU Y, et al. Development of endotracheal intubation devices for patients with tumors. American Journal of Cancer Research. 2022 Jun 15;12(6):2433-2446.
26. LIU Z-F, et al. The site of origin and expansive routes of juvenile nasopharyngeal angiofibroma (JNA). Internacional Journal of Pediatric Otorhinolaryngology, 2011;75(9):1088–92.
27. LONGACRE MM, et al. Perioperative management of pediatric patients undergoing juvenile angiofibroma resection. A case series and educational review highlighting patient blood management. Paediatric Anaesthesia, 2023;33(7):510-519.
28. LÓPEZ F, et al. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head & Neck, 2017;39(5):1033-1045.
29. MCNARRY AF, PATEL A. The evolution of airway management - new concepts and conflicts with traditional practice. Brazilian Journal of Anaesthesiology, 2017;119:i154–i166.
30. MELLO-FILHO FV, et al. Resection of a juvenile nasoangiofibroma by Le Fort I osteotomy: Experience with 40 cases. Journal of Cranio-Maxillofacial Surgery, 2015; 43 (8.
31. NEWMAN M, et al. Early-onset juvenile nasopharyngeal angiofibroma (JNA): a systematic review. World Journal of Otorhinolaryngology - Head and Neck Surgery, 2023.
32. PANDEY P, et al. Current molecular profile of juvenile nasopharyngeal angiofibroma: first comprehensive study from India. Laryngoscope, 2016;127(3):E100–6.
33. PASSI Y, et al. Comparison of the laryngoscopy views with the size 1 Miller and Macintosh laryngoscope blades lifting the epiglottis or the base of the tongue in infants and children <2 yr of age. British Journal of Anaesthesiliogy. 2014;113:869–74.
34. ROLDAN HG, et al. Nasoangiofibroma juvenil: reporte de un caso mediante abordaje de lefort I. Rev. Cir. Traumatol. Buco-Maxilo-Fac. 2024; 24(2).
35. SCHICK B, et al. Aetiology of angiofibromas: reflection on their specific vascular component. Laryngo-Rhino-Otologie, 2002.
36. SINGH RK, et al. Juvenile nasopharyngeal angiofibroma. BMJ Case Reports, 2022; 15 (3).
37. SINGH RK, et al. Endoscopic Endonasal and Transmaxillary Resection of a Nasopharyngeal Angiofibroma. World Neurosurgery, 2021.
38. SONG X, et al. Cumulative sum analysis of the learning curve for endoscopic resection of juvenile nasopharyngeal angiofibroma.Surgical Endoscopy, 2018; 32 (07): 3181-3191.
39. TORK CA, SIMPSON DL. Nasopharyngeal Angiofibroma. StatPearls Publishing. 2023
40. ZHOU Z, et al. Preoperative four-dimensional computed tomography imaging and simulation of a fibreoptic route for awake intubation in a patient with an epiglottic mass. British Journal of Anaesthesia, 2020; 125 (3): e290 - e292.
2. BAKSHI SS, BHATTACHARJEE S. Juvenile Nasopharyngeal Angiofibroma. Journal of Pediatric Hematology/Oncology, 2016;38(6):491-2.
3. BALDASSARI CM, et al. Expert Consensus Statement: Pediatric Drug-Induced Sleep Endoscopy. Otolaryngology Head & Neck Surgery, 2021; 165 (4): 578-591.
4. BHANANKER SM, et al. Anesthesia-related cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry. Anesthesia & Analgesia, 2007.
5. BOGHANI Z, et al. Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic-assisted, and open resection in 1047 cases. Laryngoscope, 2013;123(4):859–69.
6. CANGIANI LH,et al. Uso de videolaringoscópio para intubação traqueal em paciente com massa tumoral na cavidade oral: relato de caso. Brazilian Journal of Anesthesiology, 2020;70(4):434-439.
7. CHIKOTI T, et al. Juvenile Nasopharyngeal Angiofibroma Presenting with Acute Airway Obstruction. Case Reports in Otolaryngology, 2016.
8. DISMA N, et al. Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines. British Journal of Anaesthesia, 2024; 132(1):124 - 144.
9. FELIPPU AWD, et al. Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases. International Archives of Otorhinolaryngology, 2024; 28 (3), p. e432–e439.
10. FIADJOE JE, et al. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. The Lancet Respiratory Medicine, 2016; 4 (1).
11. GIBSON AC, et al. The Impact of Preoperative Flexible Fiberoptic Laryngoscopy on Anesthesia Intubation Plans. Ear, Nose & Throat Journal . 2024;0(0).
12. HACKMAN T, et al. Juvenile nasopharyngeal angiofibroma: The expanded endonasal approach. American Journal of Rhinology & Allergy. 2009;23(01):95–99.
13. HEIDEGGER T. Difficult airway management. The New England Journal of Medicine, 2021;384:1836–1847.
14. HUANG AS, et al. Focused review on management of the difficult paediatric airway. Indian Journal of Anaesthesia, 2019;63(6):428-436.
15. HUANG Y, et al. Surgical management of juvenile nasopharyngeal angiofibroma: analysis of 162 cases from 1995 to 2012. Laryngoscope. 2014;124(8):1942–6.
16. HUMPHREYS S, et al. Troca ventilatória transnasal umidificada por insuflação rápida (THRIVE) em crianças: um ensaio clínico randomizado. Brazilian Journal of Anaesthesiology, 2017;118:232–8.
17. ISELI TA, et al. Outcomes of intubation in difficult airways due to head and neck pathology. Ear Nose & Throat Journal, 2012;91:E1–E5.
18. JAGANNATHAN N, et al. Airway management for pediatric anesthesia. In HAGBERG CA, SUN LS (Ed.), Uptodate, 2024.
19. JAGANNATHAN N, BURJEK N. Troca ventilatória transnasal umidificada por insuflação rápida (THRIVE) em crianças: Um passo à frente na oxigenação apneica, mudança de paradigma na ventilação ou ambos? Brazilian Journal of Anaesthesiology, 2017;118:150–2.
20. JIMENEZ N, et al. An update on pediatric anesthesia liability: a closed claims analysis. Anesthesia & Analgesia, 2007; 104 (1).
21. KAMIYAMA K, et al. Perioperative airway management of a 16‐year‐old boy with progressive airway
obstruction due to juvenile nasopharyngeal angiofibroma. Clinical Case Reports, 2017; 5(8).
22. KRISHNA SG, et al. Management of the Difficult Airway in the Pediatric Patient. Journal of Pediatric Intensive Care, 2018;7(3):115-125.
23. LAO WP, et al. Combined endoscopic and transoral resection of a high-staged juvenile nasopharyngeal angiofibroma: A pictorial essay. Head & Neck, 2021;43(2):719-724.
24. LEWIS SR, et al. Videolaringoscopia versus laringoscopia direta para pacientes adultos que necessitam de intubação traqueal: uma revisão sistemática Cochrane. Brazilian Journal of Anaesthesiology, 2017.
25. LIU Y, et al. Development of endotracheal intubation devices for patients with tumors. American Journal of Cancer Research. 2022 Jun 15;12(6):2433-2446.
26. LIU Z-F, et al. The site of origin and expansive routes of juvenile nasopharyngeal angiofibroma (JNA). Internacional Journal of Pediatric Otorhinolaryngology, 2011;75(9):1088–92.
27. LONGACRE MM, et al. Perioperative management of pediatric patients undergoing juvenile angiofibroma resection. A case series and educational review highlighting patient blood management. Paediatric Anaesthesia, 2023;33(7):510-519.
28. LÓPEZ F, et al. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head & Neck, 2017;39(5):1033-1045.
29. MCNARRY AF, PATEL A. The evolution of airway management - new concepts and conflicts with traditional practice. Brazilian Journal of Anaesthesiology, 2017;119:i154–i166.
30. MELLO-FILHO FV, et al. Resection of a juvenile nasoangiofibroma by Le Fort I osteotomy: Experience with 40 cases. Journal of Cranio-Maxillofacial Surgery, 2015; 43 (8.
31. NEWMAN M, et al. Early-onset juvenile nasopharyngeal angiofibroma (JNA): a systematic review. World Journal of Otorhinolaryngology - Head and Neck Surgery, 2023.
32. PANDEY P, et al. Current molecular profile of juvenile nasopharyngeal angiofibroma: first comprehensive study from India. Laryngoscope, 2016;127(3):E100–6.
33. PASSI Y, et al. Comparison of the laryngoscopy views with the size 1 Miller and Macintosh laryngoscope blades lifting the epiglottis or the base of the tongue in infants and children <2 yr of age. British Journal of Anaesthesiliogy. 2014;113:869–74.
34. ROLDAN HG, et al. Nasoangiofibroma juvenil: reporte de un caso mediante abordaje de lefort I. Rev. Cir. Traumatol. Buco-Maxilo-Fac. 2024; 24(2).
35. SCHICK B, et al. Aetiology of angiofibromas: reflection on their specific vascular component. Laryngo-Rhino-Otologie, 2002.
36. SINGH RK, et al. Juvenile nasopharyngeal angiofibroma. BMJ Case Reports, 2022; 15 (3).
37. SINGH RK, et al. Endoscopic Endonasal and Transmaxillary Resection of a Nasopharyngeal Angiofibroma. World Neurosurgery, 2021.
38. SONG X, et al. Cumulative sum analysis of the learning curve for endoscopic resection of juvenile nasopharyngeal angiofibroma.Surgical Endoscopy, 2018; 32 (07): 3181-3191.
39. TORK CA, SIMPSON DL. Nasopharyngeal Angiofibroma. StatPearls Publishing. 2023
40. ZHOU Z, et al. Preoperative four-dimensional computed tomography imaging and simulation of a fibreoptic route for awake intubation in a patient with an epiglottic mass. British Journal of Anaesthesia, 2020; 125 (3): e290 - e292.