Juvenile nasopharyngeal angiofibroma.
This is a retrospective study of 17 patients with juvenile nasopharyngeal angiofibroma treated from 1983 to 1996. Patients with Stage I or II disease according to the Fisch classification system were treated surgically by a transpalatal approach. One patient underwent a Le Fort I osteotomy and down-fracture approach for access. Three patients underwent combined transpalatal and lateral rhinotomy for access, whereas one underwent a transcervical double mandibular osteotomy to facilitate the exposure. A patient with Stage IV disease underwent a combined subcranial frontonasal osteotomy plus a Le Fort I osteotomy for access to a massive angiofibroma. Initial surgical management prevented recurrence in 79% of patients. Two patients with intracranial extension were treated with primary irradiation therapy; their tumours became asymptomatic. Preoperative angiography and embolization were used to treat all surgical candidates. The use of newer craniofacial or subcranial techniques and infratemporal fossa approaches with osteotomies can provide access to large angiofibromas even when there is skull base or intracranial involvement. Surgical exposure may also be enhanced by the use of the Le Fort I osteotomy and down-fracture approaches.
Department of Otolaryngology, McGill University, Montreal, Quebec.
T L
TL
Tewfik
A K
AK
Tan
K
K
al Noury
K
K
Chowdhury
D
D
Tampieri
J
J
Raymond
T
T
Vuong
D000293:Adolescent; D018322:Angiofibroma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002648:Child; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011300:Preoperative Care; D011829:Radiation Dosage; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D014057:Tomography, X-Ray Computed