Juvenile nasopharyngeal angiofibroma: does the external approach still make sense?
OBJECTIVE
The aim of this study was to review recent management of juvenile nasopharyngeal angiofibroma (JNA) in our institution during the past 10 years and to analyze the shift in surgical paradigm based on the rate of endoscopic approach and Radkowski staging.


METHODS
Case series with chart review.


METHODS
The study was conducted from April 2000 to August 2010 in a tertiary care university hospital (Lariboisière, Paris, France).


METHODS
All patients referred for a JNA were included in the study. Medical files and imaging data were retrospectively analyzed. Surgical management was then evaluated for 2 different periods (group 1, n = 31, consecutive patients operated on from April 2000 to June 2005, and group 2, n = 41, from July 2005 to August 2010).


RESULTS
Seventy-two patients were operated on, with a mean age of 16.25 years (range, 9-33 years). The rate of the endoscopic approach was significantly higher in group 2 than in group 1 (82.9% vs 45%). Rates of recurrence and complications were similar. Recurrences (ie, residual disease growing and treated by redo) were noted in 6 cases or 8.3% (group 1, n = 3; group 2, n = 3; P > .05).


CONCLUSIONS
Progress in skull base anatomy, instrumentation, cameras, and surgical strategy allows for expansion of the indications for endoscopic removal of JNA. This approach may have a better outcome in terms of blood loss, hospital stay, and local sequelae. Still, an external approach should be considered only for selected cases due to massive intracranial extension or optic nerve or internal carotid artery entrapment by the tumor.
Head and Neck Surgery Department, Hôpital Lariboisière, Paris, France.
Tam
T
Cloutier
Yoann
Y
Pons
Jean-Philippe
JP
Blancal
Elisabeth
E
Sauvaget
Romain
R
Kania
Damien
D
Bresson
Philippe
P
Herman
D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000601:surgery*; D002648:Child; D004724:Endoscopy; D006801:Humans; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D055815:Young Adult