The Use of Radiofrequency Ablation for the Removal of Juvenile Nasopharyngeal Angiofibroma in Children

Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon, highly vascular, benign, but locally aggressive neoplasm that occurs almost exclusively in adolescent boys. The treatment of choice is complete surgical extirpation. Over the past decade, open surgical approaches have been replaced with endoscopic transnasal resection of these tumors. The advantages of endoscopic resection include better cosmesis, decreased operative time, decreased hospital stay, and more rapid return to normal activity. Because of their vascular origin, the resection of these tumors can be complicated by excessive bleeding. Numerous techniques have been developed and utilized in an attempt to circumvent this issue, the most common of which is preoperative embolization. Despite this, bleeding continues to pose a challenge during resection, and several new techniques are being explored to reduce blood loss at the point of resection. The radiofrequency ablation (Coblation, ArthroCare ENT, Austin, TX) device is a new instrument that uses bipolar radiofrequency energy and electrolytes to create a low temperature plasma field, which disrupts molecular bonds and dissolves tissue. In this report, we describe our experience over the preceding 5 years in 16 patients that underwent endoscopic transnasal resection of JNA at the Children's Hospital of Philadelphia. Seven of these patients underwent resection utilizing the radiofrequency ablation device. Patients were analyzed retrospectively and groups compared in terms of adequacy of resection, estimated blood loss, complication incidence, length of hospital stay, and recurrence. In addition, we describe the technical aspects of the use of this device in the limited space of the pediatric nasal cavity and nasopharynx.