title: Transnasal endoscopic management of angiofibroma extending to pterygopalatine and infratemporal fossae.
abstract: BACKGROUND
  Surgical approaches to the pterygopalatine and infratemporal fossae are complex and cause significant morbidity. The commonest benign tumour to extend to the pterygopalatine and infratemporal fossae is angiofibroma.
  
  
  METHODS
  This prospective study included 15 male patients aged 12-27 years with recurrent, severe epistaxis. After computed tomography and magnetic resonance imaging, a modified Wormald and Robinson's two-surgeon approach was used. Follow up, with endoscopy and magnetic resonance imaging, ranged from two to five years.
  
  
  RESULTS
  Twelve patients were cured (endoscopically and radiologically). Three patients suffered recurrence, one each in the lateral sphenoid wall, pterygoid canal and infratemporal fossa. Revision surgery was performed, but one patient suffered another recurrence (lateral sphenoid wall with cavernous sinus infiltration) and was referred for gamma knife surgery.
  
  
  CONCLUSIONS
  This endoscopic two-surgeon technique is an excellent approach for managing angiofibroma extending to the pterygopalatine and infratemporal fossae. Our modification markedly decreased morbidity by avoiding septum opening and sublabial incision, and by enabling better haemostasis (via maxillary artery control). Recurrence may be minimised by careful examination of the lateral sphenoid wall, pterygoid canal and infratemporal fossa pterygoid muscles.
authors.affiliation: Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Egypt. shawky_morsy2003@yahoo .com
authors.forename: S M
authors.initials: SM
authors.lastname: El Morsy
authors.forename: Y W
authors.initials: YW
authors.lastname: Khafagy
mesh_terms: D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002648:Child; D004564:Electrocoagulation; D004844:Epistaxis / Q000209:etiology* / Q000601:surgery; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008438:Maxillary Artery / Q000601:surgery; D009303:Nasopharyngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D056739:Pterygopalatine Fossa; D012086:Reoperation; D055502:Secondary Prevention; D012886:Skull; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult