Transoral "adenoidectomy" excision of juvenile nasopharyngeal angiofibromas.
OBJECTIVE
We describe a minimally invasive technique for excision of selected juvenile nasopharyngeal angiofibromas (JNAs) using indirect visualization of the nasopharynx.


METHODS
An observational case series with follow-up of 9 months to 3 years was performed. The subjects included 4 teenage boys with early-stage nasopharyngeal angiofibromas. The intervention included computed tomography, magnetic resonance imaging, angiography and embolization, tumor excision, pathologic examination, and follow-up. The outcome measures included blood loss, perioperative morbidity, and surgical cure.


RESULTS
Four teenage boys underwent excision of early stage JNAs--3 with preoperative embolization. The JNAs were excised under indirect mirror guidance with an adenoid curette and the nasopharynx packed. Residual tumor was removed endoscopically. The operative time was less than 1 hour in each case, and blood loss was less than 100 mL. All 4 boys are free of disease.


CONCLUSIONS
With the advent of refined imaging techniques and relatively safe preoperative embolization, minimally invasive approaches to JNA excision have been advocated. Endoscopic transnasal piecemeal excision is feasible but time-consuming. Transoral avulsion of the tumor mass by adenoidectomy techniques combined with endoscopic removal of tumor remnants from the pterygopalatine fossa allows complete, controlled surgical excision with minimal blood loss.
Solomon
Don
D
Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine and Temple University Children's Medical Center, Philadelphia, Pennsylvania 19140, USA.
Isaacson
Glenn
G
D000233:Adenoidectomy / Q000379:methods*; D000293:Adolescent; D018322:Angiofibroma / Q000473:pathology / Q000601:surgery*; D000792:Angiography; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009055:Mouth; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome