Surgical approaches to juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibromas are highly vascular, non-encapsulated tumours affecting predominantly young males. These lesions are benign histologically but they may become life-threatening with excessive bleeding or intracranial extension. The surgical approaches to 22 male patients with na...

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Bibliographic Details
Published in:Journal of cranio-maxillo-facial surgery 2006, Vol.34 (1), p.3-8
Main Authors: Cansiz, Harun, Güvenç, M. Güven, Şekercİoğlu, Nihat
Format: Article
Language:English
Subjects:
Adolescent
Adult
Angiofibroma - surgery
Biological and medical sciences
Carotid Artery Injuries - etiology
Carotid Artery, Internal - pathology
Child
Craniotomy - adverse effects
Dentistry
Endoscopy
Facial Paralysis - etiology
Frontal Bone - surgery
Humans
juvenile nasopharyngeal angiofibroma
Male
Medical sciences
modified midfacial degloving
Nasopharyngeal Neoplasms - surgery
Neoplasm Staging
Nose - surgery
Nose Diseases - etiology
Oral Surgical Procedures - methods
Otorhinolaryngology. Stomatology
Paresthesia - etiology
Postoperative Complications
Retrospective Studies
Rupture
surgical approach
Temporal Bone - surgery
Treatment Outcome
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Summary:Juvenile nasopharyngeal angiofibromas are highly vascular, non-encapsulated tumours affecting predominantly young males. These lesions are benign histologically but they may become life-threatening with excessive bleeding or intracranial extension. The surgical approaches to 22 male patients with nasopharyngeal angiofibromas are reviewed. A modification of midfacial degloving performed without rhinoplasty incisions and lateral osteotomies is described. The patients’ ages ranged between 9 and 26 years (mean 14.9). Three stage I tumours, 8 stage II tumours, 6 stage III tumours and 5 stage IV tumours were included into this study. All stage I lesions and one stage II lesion were treated via transnasal endoscopic approach. A modified midfacial degloving approach was used for the removal of seven other stage II lesions, all six stage III lesions, and three stage IV lesions. A combined midfacial degloving-infratemporal fossa Fisch C-transcranial approach was the route chosen for the remaining two stage IV lesions. The complications encountered in the postoperative course include temporary facial palsy in one patient (following a Fisch C infratemporal resection), mild crusting in the nasal cavity in 8 patients, and facial paraesthesia in 6 patients whose tumours were resected via midfacial degloving, and rupture of the subpetrous part of the internal carotid artery in one patient. The suggested treatment of juvenile nasopharyngeal angiofibroma consists of an endoscopic transnasal approach for early stage lesions, and a modified midfacial degloving for almost all of the advanced lesions. The latter approach is very useful considering surgical exposure, duration of surgery, cosmetic outcome, and morbidity. It can be combined with an infratemporal approach or craniotomy if necessary.
ISSN:1010-5182
1878-4119
DOI:10.1016/j.jcms.2005.08.006