title: The changing surgical management of juvenile nasopharyngeal angiofibroma.
abstract: The management of juvenile nasopharyngeal angiofibroma (JNA) has changed during the last decades but it still continues to be a challenge for the multidisciplinary head and neck surgical team. The aim of this study was to review the used treatment approach and outcome of JNA in a single institution series of 27 patients diagnosed and treated during the years 1970-2009. All patients were male, with the median age of 17 years (range 11-33 years). Surgery was used as the primary treatment in every case. Surgical approaches varied, transpalatal approach (N = 14) being the most common approach used in this series. During the last decade various other techniques were applied, including endoscopic (N = 3) resection. Two patients were additionally treated with antiangiogenic agents and one patient with stereotactic radiotherapy. The primary recurrence rate was 37% and it seemed to correlate with vascular density of tumour and the surgical approach used. We suggest that the management of JNA should be planned by an experienced head and neck surgeon, as part of a multidisciplinary team, preferably in a tertiary referral setting, and the recent development of the available therapies should be taken into account to minimise the risk of recurrence.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, 00029, Helsinki, Finland.
authors.forename: Suvi
authors.initials: S
authors.lastname: Renkonen
authors.forename: Jaana
authors.initials: J
authors.lastname: Hagström
authors.forename: Jyrki
authors.initials: J
authors.lastname: Vuola
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Matti
authors.initials: M
authors.lastname: Porras
authors.forename: Sanna-Maria
authors.initials: SM
authors.lastname: Kivivuori
authors.forename: Ilmo
authors.initials: I
authors.lastname: Leivo
authors.forename: Antti A
authors.initials: AA
authors.lastname: Mäkitie
mesh_terms: D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000175:diagnosis / Q000628:therapy*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D004724:Endoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D009367:Neoplasm Staging; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D016634:Radiosurgery / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents