Nasopharyngeal angiofibroma

Nasopharyngeal angiofibromas are uncommon neoplasms, which are histologically benign but locally invasive and destructive. They mostly affect the nose and nasopharynx, but may extend to the adjacent structures. The first choice of treatment is surgery. This paper presents our experience in the management of nasopharyngeal angiofibroma.

We retrospectively reviewed 13 patients of nasopharyngeal angiofibroma attending the Department of Otorhinolaryngology at Taipei Veterans General Hospital (VGH-TPE) from 1979 to 1999. Two patients recurred after surgery at other hospitals and were excluded from this study. Eleven patients underwent the primary surgery and were included for statistical analysis. The relationship between preoperative embolization and intraoperative effective blood loss (EBL) was also discussed.

The incidence was about 1 per 5,000 otorhinolaryngology admissions. The ratio of female to male was 1 to 10. The median age of symptom onset was 18 years. There were 7, 3 and 1 patients in IA, IB and IIA stages of Sessions' classification. Seven patients underwent preoperative embolization. One patient was treated with stilbestrol preoperatively. Of the surgical procedures, transpalatal approach was the most often performed (8/11). Postoperative radiotherapy (1,000 cGy) was administered to 1 patient due to the suspected residual tumor. The average intraoperative EBL was 731.8 ml. Patients with preoperative embolization had an average EBL of 814.3 ml and those without embolization had an average EBL of 587.5 ml. The difference of EBL between the patients with and without preoperative embolization was not statistically significant. The average follow-up duration was 118.4 months and no tumor recurred.

Surgery is the main therapeutic option for nasopharyngeal angiofibroma. We suggest preoperative embolization. Radiotherapy is an adjuvant treatment and reserved for the patients with advanced stage or recurrent tumors.