Recent advances in the treatment of juvenile angiofibroma.
OBJECTIVE
Juvenile nasopharyngeal angiofibroma is a rare vascular tumor almost exclusive to the nasopharynx of adolescent males. Traditionally, juvenile nasopharyngeal angiofibroma has been treated surgically using open surgical approaches and has been associated with frustratingly high recurrence rates. This article reviews recent contributions to the study and treatment of this disease. In particular, advances in minimally invasive endoscopic resection of juvenile nasopharyngeal angiofibroma are evaluated.


RESULTS
The growth patterns of juvenile nasopharyngeal angiofibroma are evaluated. Young age does not appear to correlate with more aggressive disease. The major recent advance in the treatment of juvenile nasopharyngeal angiofibroma has been the application of endoscopic endonasal surgery to the treatment of select tumors. This article reviews the indications and inclusion criteria recently put forth to help select patients for this minimally invasive approach. In properly selected patients with Radkowski stage I and II lesions, recurrence rates range between 0 and 7%. Advanced lesions continue, in most cases, to require open approaches, some of which are also presented.


CONCLUSIONS
With proper patient selection, endoscopic resection of juvenile nasopharyngeal angiofibroma is feasible and may be preferable to traditional open approaches. Results suggest that after endonasal resection, disease recurrence is low. Most larger lesions, especially those with intracranial spread, continue to require open approaches for complete resection.
Enepekides
Danny J
DJ
Department of Otolaryngology, University of California Davis Medical Center, Sacramento, California 95817, USA. danny.enepekides@ucdmc.ucdavis.edu
D018322:Angiofibroma / Q000473:pathology / Q000601:surgery*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D004724:Endoscopy; D005485:Flutamide / Q000627:therapeutic use; D006801:Humans; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D005485:Flutamide