title: Juvenile nasopharyngeal angiofibroma: experience at a tertiary care centre in Pakistan.
abstract: OBJECTIVE
  To review the clinical presentations of Juvenile nasopharyngeal angiofibroma surgical approaches used and outcomes of patients at an urban tertiary care centre in Pakistan.
  
  
  METHODS
  The retrospective study was conducted at Aga Khan University Hospital, Karachi, involving medical records of patients with histologically confirmed Juvenile nasopharyngeal angiofibroma who were treated between 2000 and 2008.
  
  
  RESULTS
  Eighteen male patients were identified, with an average age at diagnosis of 16 5.6 (range 11-28) years. Most patients (n = 16; 88.9%) presented with epistaxis. CT scan was the most common (n = 17; 94.44%) radiological investigation for staging. Blood supply of the tumour was varied (ipsilateral or bilateral internal maxillary artery). According to Andrews staging, 4 (22.22%) patients presented with stage I disease; 5 (27.77%) with stage II; 4 (22.22%) with stage IIIa; 1 (5.55%) with stage IIIb; and 4 (22.22%) with stage IVb disease. Of the 18 patients, 17 (94.44%) underwent 19 surgical procedures, with a recurrence rate of 10.5% (n=2) and incomplete resection in 15.8% (n = 3) procedures. Lateral rhinotomy was the most frequently employed (n = 13; 68.42%) surgical approach in the 19 surgical procedures conducted at the AKUH.
  
  
  CONCLUSIONS
  Surgery continues to be the mainstay treatment modality. Surgical approach is dependent on various disease factors as well as institutional resources. In situations of limited resources, the condition may still be managed effectively with traditional approaches that result in good functional outcome and low morbidity.
authors.affiliation: Medical College, Aga Khan University, Karachi, Pakistan. adeel.ahmed.shamim@gmail.com
authors.forename: Adeel Ahmed
authors.initials: AA
authors.lastname: Shamim
authors.forename: Kulsoom
authors.initials: K
authors.lastname: Ghias
authors.forename: Mumtaz Jamshed
authors.initials: MJ
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018322:Angiofibroma / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D006801:Humans; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D010154:Pakistan; D012189:Retrospective Studies; D063128:Tertiary Health Care; D016896:Treatment Outcome; D055815:Young Adult