title: [Evolution in the treatment of juvenile nasopharyngeal angiofibroma].
abstract: BACKGROUND
  Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumour in adolescent males. It may be associated with a significant morbidity because of its anatomical location and its locally destructive growth pattern. Severe haemorrhage constitutes a high risk in JNA and its surgical management could be complex.
  
  
  METHODS
  We retrospectively analysed the clinical data from 43 patients with JNA surgically treated in our Department from 1993 until 2010. Mean postoperative follow-up time was 85 months.
  
  
  RESULTS
  Analysis was performed on 42 males and one female. Mean patient age was 16 years old. The most common presenting symptoms were unilateral epistaxis (56%) and nasal obstruction (56%). Using the Fisch staging scale, tumours were classified as stage I in 2 patients, stage II in 9, stage III-a in 13, stage III-b in 13 and stage IV-a in 6. Preoperative selective embolisation was performed on 32 patients (74%). Thirty-three patients (77%) underwent an open surgical approach and 10 (23%) were treated by endoscopic approach. Complete resection of the lesion was achieved in 35 patients (81%) and tumour recurrence was observed in 2 (5%). All lesions treated via transnasal endoscopic approach were stage I and stage II lesions.
  
  
  CONCLUSIONS
  Surgery is the treatment of choice for JNA. An endoscopic approach is feasible for early-stage lesions (Fisch I and II) and conservative external approaches are still useful in advanced stages (Fisch III and IV). The open approaches proved helpful with respect to exposure, safety, cosmetic outcome and low morbidity. Preoperative embolisation, if possible, is mandatory.
authors.affiliation: Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, España. llorentependas@telefonica.net
authors.forename: José Luis
authors.initials: JL
authors.lastname: Llorente
authors.forename: Fernando
authors.initials: F
authors.lastname: López
authors.forename: Vanessa
authors.initials: V
authors.lastname: Suárez
authors.forename: María
authors.initials: M
authors.lastname: Costales
authors.forename: Carlos
authors.initials: C
authors.lastname: Suárez
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D018322:Angiofibroma / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002648:Child; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D004724:Endoscopy / Q000379:methods*; D004844:Epistaxis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D015508:Nasal Obstruction / Q000209:etiology; D009303:Nasopharyngeal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D013517:Otorhinolaryngologic Surgical Procedures / Q000639:trends*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult