Juvenile nasopharyngeal angiofibroma: a revised staging system.
OBJECTIVE
To discuss the shortcomings of current staging systems and to suggest modifications according to new surgical methods and data.


METHODS
A retrospective chart review.


METHODS
The medical records of 36 patients, all of whom underwent resection of juvenile nasopharyngeal angiofibroma by external or endonasal approach between 1983 and 2002, were reviewed retrospectively. Follow-up period of patients ranged from 3 to 7 years (mean, 4.5 years). Tumour extent, sites and rate of persistent disease were analyzed and compared with the literature.


RESULTS
Persistent or recurrent disease was found in 12 of the 36 patients (33%). The primary tumour of these 12 cases invaded one or more anatomic region beside nasopharynx: the base of the pterygoid process in 9 cases (75%), the infratemporal fossa in 4 (33%), the pterygomaxillar fossa in 4 (33%), and the sphenoid sinus in 2 cases (17%). Involvement of the pterygoid process base was observed in only 3 of the 24 patients without persistent disease, whereas it was found 10 out of 12 patients with persistent disease.


CONCLUSIONS
Advances in radiographic imaging, embolization, and surgical methods of treating angiofibromas have changed the sites associated with a high risk for persistent disease or morbidity. These changes have made it necessary for the authors to devise more appropriate classifications and, subsequently, several new staging systems were gradually introduced. Recent technological advances, particularly angled endoscopes, have resulted in improved exposure. In the light of all these recent advances, data from our series, and the literature, we suggested a new classification for determining the risk of persistent disease, choosing the appropriate surgical method, and for maintaining uniformity.
Department of Otorhinolaryngology Head and Neck Surgery, Hacettepe University Medical Faculty, Ankara, Turkey. metin@tr.net
Metin
M
Onerci
Oğuz
O
Oğretmenoğlu
Taşkin
T
Yücel
D000293:Adolescent; D018322:Angiofibroma; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed