Surgical Management of Nasopharyngeal Angiofibroma: The Rotterdam Experience

Purpose: To present our experience with the various surgical approaches for nasopharyngeal angiofibroma.

Method: The medical records of 35 patients treated between the years 1981 to 2005 were examined with emphasis on the clinical extent of the tumor upon presentation, the surgical approach, postmanagement complications, and patterns of recurrences.

Result: Before 1992, the preferred surgical approaches were transnasal, transpalatal, and combined transnasal transpalatal approaches. These techniques were applied in 11 patients. Although no major recurrences were observed, due to growing concerns about postoperative complications such as persistent palatal fistula formation in three patients and unsightly scar formation in two patients, the aforementioned techniques were replaced with the Denker and midfacial degloving techniques. From 1992 onward a total of 18 patients underwent the Denker procedure, 3 of whom had recurrences managed surgically using the same approach (2 patients) or the lateral infratemporal approach (1 patient). In the same period, 6 patients underwent the midfacial degloving technique of whom one had a recurrence managed surgically using the same procedure. Both techniques led to fewer major complications.

Conclusion: From our experience both the Denker and the midfacial degloving techniques can be effective in removing angiofibromas with minimal extension in the infratemporal fossa. For larger angiofibromas with further infratemporal or intracranial extension, an endoscope-assisted technique or the classic infratemporal approaches should always be considered.