Recurrence and its avoidance in juvenile angiofibroma

Objective. Angiofibroma is a highly vascular lesion for which a wide range of surgical approaches has been recommended. Irrespective of the approach, a significant and often rapid recurrence rate is reported in all major seri es. Aim To consider the impact of lessons learned from imaging on the recur rence rate of angiofibroma. Material and Methods. From a cohort of 90 male patients with histologically proven angiofibroma, 40 individuals were studi ed. The recurrence rate in 20 cases treated before March 1998 was compared with that in 19 cases treated thereafter. In the latter group, an additiona l exploration of the basisphenoid had been undertaken. Results. The two coh orts were comparable in age range (7-27 y and 11-24 years, respectively), a nd all had been treated by midfacial degloving. In the first group, 8 recur rences occurred which were multiple in 1 patient. In the next 19 patients, the area of the pterygoid canal was meticulously explored and the basisphen oid drilled to remove all residual tumor. No recurrences have occurred in t his group during a follow-up of between 6 months to 3 years. Conclusion. Me ticulous removal of angiofibroma infiltrating the pterygoid canal and basis phenoid is paramount to avoid "recurrence."