Endonasal Surgical Treatment of Angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is one of the benign tumors of the head and neck behaving locally in a malignant fashion, challenging the surgeon. It originates at the posterosuperior margin of the sphenopalatine foramen. It predominantly occurs in adolescent males and accounts for 0.05% of all head and neck neoplasms. Although JNA is histologically benign, it can cause significant morbidity and on some occasions mortality due to extensive spread to adjacent structures. The extension of the tumor and the bleeding during surgery makes the surgery more difficult. However, with new techniques and developing facilities such as endoscopy, navigation, and embolization, we are experiencing a revolution in the surgery of angiofibroma.

Since this tumor does not invade the tissues, it can be removed with blunt dissection after opening or removing all the bony coverings that prevent access to the tumor. The basis of the pterygoids is the most common site for recurrence. Endoscopic removal of JNA with preoperative embolization is appropriate in selected cases. Complete removal with minimal morbidity is possible. The conventional staging systems do not predict the prognosis with an endoscopic approach. Special emphasis is placed on the problems of staging systems. The details of the surgical technique and the indications for embolization will be discussed.