Temporal approach for resection of juvenile nasopharyngeal angiofibromas

Objective: To describe a lateral preauricular temporal approach for resecti on of juvenile nasopharyngeal angiofibroma (JNA). Study Design: A retrospec tive review of five patients with JNA tumors that were resected by a latera l preauricular temporal approach. Methods: The medical records of five pati ents who underwent resection of JNA tumors via a lateral preauricular tempo ral approach were reviewed, and the following data collected: tumor extent, blood loss, hospital stay, and surgical complications, Results: Five patie nts with JNA tumors had resection by a lateral preauricular temporal approa ch. These tumors ranged from relatively Limited disease to more extensive i ntracranial, extradural tumors, Using the staging system advocated by Andre ws et al.,(1) these tumors included stages II, IIIa, and IIIb, Four patient s (stages II, IIIa, IIIa, and IIIb) who underwent primary surgical excision had minimal blood losses and were discharged on the first or third postope rative day with minimal transient complications (mild trismus, frontal bran ch paresis, serous effusion, and cheek hypesthesia), The remaining patient (stage IIIb) did well after surgery, despite having undergone preoperative radiation therapy and sustaining a significant intraoperative blood loss. T here have been no permanent complications or tumor recurrences. Conclusions : A lateral preauricular temporal approach to the nasopharynx and infratemp oral fossa provides effective exposure for resection of extradural JNA tumo rs. The advantages of this approach include a straightforward route to the site of origin, the absence of facial and palatal incisions, and avoidance of a permanent ipsilateral conductive hearing loss.