title: Angiofibroma: an outcome review of conventional surgical approaches.
abstract: Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasopharynx, and for its treatment, many surgical approaches have been recommended. However, selecting the appropriate one for the tumor in an advanced stage is still controversial. In this study, we evaluate the rate of recurrence of JNA and its relationship to the preoperative stage as well as various surgical approaches. Thirty-seven patients with pathologically proven JNA were retrospectively analyzed. For each patient, data were obtained regarding the primary extension, various surgical approaches and rate of recurrence. Seven patients were in stage III with intracranial extensions. Two of these patients had symptomatic recurrence that needed surgery. Three of them were disease free, and in two cases residues were demonstrated that were asymptomatic and were chosen only to be observed. Among different surgical approaches used, the transpalatal resulted in 1 recurrence out of 14 patients treated with this approach when the lesion was limited to the nasal cavity, nasopharynx and paranasal sinuses (stage I). No recurrence was observed with the use of this approach with lesions with minimal extension to the pterygopalatine fossa (stage IIA). But among three patients with intracranial extension who were treated with this approach, two resulted in symptomatic recurrence; however, using the Lefort I surgical technique, no evidence of recurrence was observed in the two patients in stage III who were treated with this approach. Involvement of the orbit, middle cranial fossa and base of the pterygoid by the primary JNA results in a higher incident of recurrent tumor. Among different surgical techniques, the lowest recurrence rate is seen either in the transpalatal approach when the tumor is limited to the nasopharynx with extension to the nasal cavity or paranasal sinuses or with the Lefort I approach when skull base invasion is present.
authors.affiliation: Department of ENT of Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Mousa Sadr
authors.initials: SM
authors.lastname: Hosseini
authors.forename: Peyman
authors.initials: P
authors.lastname: Borghei
authors.forename: Seyed Hebatodin
authors.initials: SH
authors.lastname: Borghei
authors.forename: Mohammad Taghi Khorsandi
authors.initials: MT
authors.lastname: Ashtiani
authors.forename: Ali
authors.initials: A
authors.lastname: Shirkhoda
mesh_terms: D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002648:Child; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
references.citation: J Laryngol Otol. 1988 Sep;102(9):805-9
references.pmid: 2844939
references.citation: Cancer. 1982 Jan 15;49(2):369-71
references.pmid: 6274507
references.citation: ORL J Otorhinolaryngol Relat Spec. 2003 Jul-Aug;65(4):238-41
references.pmid: 14564102
references.citation: Head Neck. 1992 Jan-Feb;14(1):67-71
references.pmid: 1320599
references.citation: Am J Otolaryngol. 2004 May-Jun;25(3):157-61
references.pmid: 15124163
references.citation: Eur Arch Otorhinolaryngol. 1997;254(4):200-4
references.pmid: 9151020
references.citation: Otolaryngol Head Neck Surg. 1992 Mar;106(3):278-84
references.pmid: 1317030
references.citation: Head Neck. 1997 Aug;19(5):391-9
references.pmid: 9243266
references.citation: Laryngoscope. 1989 Apr;99(4):429-37
references.pmid: 2538688
references.citation: Eur Arch Otorhinolaryngol. 2001 Mar;258(3):120-4
references.pmid: 11374252
references.citation: Laryngoscope. 1984 Dec;94(12 Pt 1):1599-605
references.pmid: 6094932
references.citation: Head Neck. 1996 Jan-Feb;18(1):60-6
references.pmid: 8774923
references.citation: J Neurooncol. 1994;20(3):213-40
references.pmid: 7844620
references.citation: J Laryngol Otol. 1996 Oct;110(10 ):962-8
references.pmid: 8977863
references.citation: Laryngoscope. 1983 Jan;93(1):36-44
references.pmid: 6185810
references.citation: Laryngoscope. 1989 Apr;99(4):398-401
references.pmid: 2538686
references.citation: Am J Otolaryngol. 2002 Sep-Oct;23(5):282-6
references.pmid: 12239693
references.citation: Arch Otolaryngol Head Neck Surg. 1996 Feb;122(2):122-9
references.pmid: 8630204
references.citation: Laryngoscope. 2001 Apr;111(4 Pt 1):681-7
references.pmid: 11359140
references.citation: Otolaryngol Head Neck Surg. 1985 Dec;93(6):803-6
references.pmid: 3003654
references.citation: Arch Otolaryngol Head Neck Surg. 1986 Jul;112(7):750-2
references.pmid: 3707738
references.citation: Arch Otolaryngol Head Neck Surg. 1987 Sep;113(9):936-42
references.pmid: 3038146
references.citation: J Neurooncol. 1994;20(3):291-312
references.pmid: 7844623
references.citation: Acta Otorhinolaryngol Belg. 2000;54(2):201-19
references.pmid: 10892510
references.citation: Laryngoscope. 2003 May;113(5):775-82
references.pmid: 12792310
references.citation: Clin Otolaryngol Allied Sci. 2002 Dec;27(6):536-40
references.pmid: 12472527
references.citation: Laryngoscope. 2004 Feb;114(2):291-3
references.pmid: 14755205
references.citation: Histopathology. 1986 May;10(5):543-51
references.pmid: 2424818
references.citation: Laryngoscope. 1999 Jan;109 (1):140-7
references.pmid: 9917056
references.citation: Int J Pediatr Otorhinolaryngol. 2003 Nov;67(11):1219-25
references.pmid: 14597374
references.citation: Laryngoscope. 1987 Nov;97(11):1319-25
references.pmid: 2823033
references.citation: Laryngoscope. 2001 Sep;111(9):1509-11
references.pmid: 11568597