Juvenile nasopharyngeal angiofibroma

This is a retrospective study of 17 patients with juvenile nasopharyngeal a ngiofibroma treated from 1983 to 1996. Patients with Stage I or II disease according to the Fisch classification system were treated surgically by a t ranspalatal approach. One patient underwent a Le Fort I osteotomy and down- fracture approach for access. Three patients underwent combined transpalata l and lateral rhinotomy far access, whereas one underwent a transcervical d ouble mandibular osteotomy to facilitate the exposure. A patient with Stage IV disease underwent a combined subcranial frontonasal osteotomy plus a Le Fort I osteotomy for access to a massive angiofibroma. Initial surgical ma nagement prevented recurrence in 79% of patients. Two patients with intracr anial extension were treated with primary irradiation therapy; their tumour s became asymptomatic. Preoperative angiography and embolization were used to treat all surgical candidates. The use of newer craniofacial or subcrani al techniques and infratemporal fossa approaches with osteotomies can provi de access to large angiofibromas even when there is skull base or intracran ial involvement. Surgical exposure may also be enhanced by the use of the L e Fort I osteotomy and down-fracture approaches.