title: Endoscopic-assisted midfacial degloving approach for type III juvenile angiofibroma.
abstract: BACKGROUND
  Open surgery is the mainstay treatment for juvenile angiofibromas (JAF). Midfacial degloving approach provides good exposure to the target area with excellent cosmoses. Endoscopic techniques have been used for the removal of some small JAF.
  
  
  OBJECTIVE
  To evaluate the efficacy and outcome of endoscopic-assisted midfacial degloving approach as a route for removal of type III juvenile angiofibroma.
  
  
  METHODS
  Fifteen young male patients with type III JAF (based on Fisch classification by computed tomography (CT) and magnetic resonance imaging (MRI) or both), were operated on by endoscopic-assisted midfacial degloving approach. Pre-operative angiography and embolization were performed in two patients. The surgical technique is described in details.
  
  
  RESULTS
  Apart from a case developed cerebrospinal fluid (CSF) rhinorrhea intraoperatively there were neither major operative nor post-operative complications. CSF leak was repaired through the same approach successfully in the same set. Thirteen patients had complete tumor clearance with no residual or recurrence during the follow-up period which ranged from 6 months to 6 years. Recurrence was detected early by endoscopic examination in two cases (3 and 8 months post-operatively) and confirmed by CT and MRI. Endoscopic transnasal removal of the recurrent JAF was done successfully under local anesthesia in the first patient and under general anesthesia in the second with no recurrence during the follow-up period.
  
  
  CONCLUSIONS
  Endoscopic-assisted midfacial degloving approach for removal of type III JAF enables the surgeon to gain the advantages of midfacial degloving approach with extensive exposure of the surgical field. Employing an endoscope, offers safe dealing with serious intraoperative complications like CSF leak. Post-operative follow-up by endoscopic nasal examination can detect early recurrence, which can be confirmed by CT and MRI.
authors.affiliation: Department of ENT, Faculty of Medicine, El Menoufyia University, El Menoufyia, Egypt. welbanhawy@hotmail.com
authors.forename: Omar A
authors.initials: OA
authors.lastname: El-Banhawy
authors.forename: Abd El-Hafiz
authors.initials: Ael-H
authors.lastname: Shehab El-Dien
authors.forename: Talal
authors.initials: T
authors.lastname: Amer
mesh_terms: D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D004534:Egypt; D004724:Endoscopy / Q000379:methods; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008279:Magnetic Resonance Imaging; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome