Endoscopic laser-assisted excision of juvenile nasopharyngeal angiofibromas.
BACKGROUND
Juvenile nasopharyngeal angiofibromas (JNAs) are highly vascular tumors that originate in the nasopharynx of young males. The primary treatment is surgical excision. Traditional surgical approaches are associated with significant morbidity and facial deformity. We introduce and outline the clinical advantages of an endoscopic surgical approach to JNAs using the Nd:YAG laser with image-guided surgery.


METHODS
Case series.


METHODS
Tertiary care medical center.


METHODS
Our study included 5 male patients (age range, 8-21 years) with extensive JNAs. Their tumors were large and ranged from Fisch stage IIA to IIIA. Embolization of tumor-feeding vessels was performed before surgery. The tumors were photocoagulated via a transnasal endoscopic approach using a Nd:YAG laser. Devascularized, lased tumor was removed with a microdebrider. Image-guided navigation systems were used to assist skull base tumor removal, and sublabial and buccolabial incisions were used as needed to gain lateral endoscopic tumor access. Endoscopic tumor margins were obtained for frozen section.


RESULTS
All patients achieved symptomatic remission, with no complications. No blood transfusions were necessary. The patients were ready for discharge 1 to 2 days after surgery. Postoperative and magnetic resonance imaging scans showed 2 skull base recurrences, which were removed endoscopically. Follow-up ranged between 2 and 3 years.


CONCLUSIONS
Traditional external surgical approaches to large JNAs may result in significant morbidity. Laser-assisted image-guided endoscopic excision of JNAs is a safe and effective minimally invasive surgical treatment. Its distinct advantages include (1) diminished blood loss, (2) superior cosmesis without observed altered facial growth, (3) direct access of skull base with minimal morbidity, and (4) ease of endoscopic follow-up.
Mair
Eric A
EA
Otolaryngology Service, Walter Reed Army Medical Center, Washington, DC, USA. eric.mair@lackland.af.mil
Battiata
Andrew
A
Casler
John D
JD
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018322:Angiofibroma / Q000473:pathology / Q000601:surgery*; D002648:Child; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D017063:Outcome Assessment, Health Care