title: Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign.
abstract: Imaging plays an important role in the diagnosis, staging and prognosis of JNA. Certain radiological changes as seen on CECT were observed to be consistent in our case series. This study analysed preoperative and postoperative CECT of large series of JNA patients to evaluate the sites and pattern of spread of tumor. We evaluated the clinical significance of pterygoid wedge in preoperative and postoperative imaging and thus elucidating two new radiological signs. Retrospective analysis of the pre operative and post operative imaging data of 242 patients with JNA. The findings in the scan were clinically correlated with the endoscopic intraoperative findings. Preoperative evaluation of the pterygoid wedge revealed widening on the involved side in 99.1% of our cases which is 1.8 times greater compared to the uninvolved side. The possibility of residual/recurrent tumor was found to be significantly higher in those where the pterygoid wedge was not removed by drilling (p< 0.001) Drilling of the pterygoid wedge intra operatively, reduced the rate of residual/recurrence from 31.9 to 3.07%. Widening of the pterygoid wedge seen in the preoperative CECT, referred as RAM HARAN sign occurs in JNA. It has a significant diagnostic value as a radiological sign in JNA. Drilling of the pterygoid wedge intraoperatively reduces the rate of recurrence of JNA. Appearance of the two pterygoid plates on postoperative CECT, as two parallel lines, referred as Chopstick sign, has a remarkable prognostic value as a radiological sign in JNA.
authors.affiliation: Royal Pearl Hospital, Tiruchirapalli, Tamilnadu India.
authors.forename: Trichy Narayanan
authors.initials: TN
authors.lastname: Janakiram
authors.affiliation: Royal Pearl Hospital, Tiruchirapalli, Tamilnadu India.
authors.forename: Shilpee Bhatia
authors.initials: SB
authors.lastname: Sharma
authors.affiliation: Royal Pearl Hospital, Tiruchirapalli, Tamilnadu India.
authors.forename: Udaya Chanukya
authors.initials: UC
authors.lastname: Samavedam
authors.affiliation: Royal Pearl Hospital, Tiruchirapalli, Tamilnadu India.
authors.forename: Onkar
authors.initials: O
authors.lastname: Deshmukh
authors.affiliation: Magnum Imaging and Diagnostics Pvt. Ltd., Tiruchirapalli, Tamilnadu India.
authors.forename: Bavaharan
authors.initials: B
authors.lastname: Rajalingam
keywords: Chopstick sign; JNA; Juvenile nasopharyngeal angiofibroma; Pteygoid wedge; Ramharan sign