title: Staging and surgical approaches in large juvenile angiofibroma--study of 95 cases.
abstract: BACKGROUND
  Surgery has been the treatment of choice for juvenile nasopharyngeal angiofibroma (JNA) and selection of proper surgical approach depends primarily upon the extensions of the tumor. Minimal external deformity/surgical scar without affecting growth pattern of facial skeleton of patient along with extensions of JNA were the basis of selecting surgical approach in present study.
  
  
  METHODS
  The medical records of 95 patients with histologically proven large JNA who underwent treatment in our institution between 1992 and 2002 were reviewed retrospectively. Inclusion criterion-Stage II, III, IV JNA, minimum available follow up of 2 years. Exclusion criterion-Stage I JNA, follow up of less than 2 years. Lazy S incision was used and combined transmaxillary and transpalatal removal of angiofibroma was done in most of the cases.
  
  
  RESULTS
  Complete removal of JNA was achieved in 78 (82%) cases in single surgery. Residual tumor was found in 17 (18%) cases.
  
  
  CONCLUSIONS
  Infratemporal, pterygopalatine, orbital and intracranial extensions of JNA (Stage IIIa and IIIb) can be removed by combined transpalatal and transmaxillary approach by Lazy S incision without producing any facial asymmetry or cosmetic defect. Conservative lateral infratemporal approach (type D1 approach) is required in very large lateral extensions or where JNA is extending intracranially through foramen ovale. Staged fronto-temporal craniotomy should be done in Stage IVa tumors (large intracranial extensions). In Stage IVb tumors (invading cavernous sinus), usually residual tumor remains which should be followed subsequently.
authors.affiliation: Neuro-otology Unit, Department of Neuro-surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareily Road, Lucknow 226014, UP, India. ityagi@sgpgi.ac.in <ityagi@sgpgi.ac.in>
authors.forename: Isha
authors.initials: I
authors.lastname: Tyagi
authors.forename: Rajan
authors.initials: R
authors.lastname: Syal
authors.forename: Amit
authors.initials: A
authors.lastname: Goyal
mesh_terms: D018322:Angiofibroma / Q000473:pathology* / Q000601:surgery*; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies