Endonasal Surgical Treatment of Angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor that behaves locally in a malignant fashion, challenging the surgeon. It originates at the superior 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 submucosal spread to adjacent structures. The extension of the tumor and the bleeding during surgery make the surgery increasingly difficult. However, with new and developing techniques such as endoscopy, navigation, and embolization, we are experiencing a revolution in the surgery of angiofibroma.

Since the tumor does not invade the tissues, it can be removed with blunt dissection after opening all the bony coverings that prevent access to the tumor. Special emphasis is given to basis pterygoids, 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 details of the surgical technique and the indications for embolization will be discussed.