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Recurrence and its avoidance in juvenile angiofibroma
1Institute of Laryngology & Otology, University College London, UK.
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 series.
Aim:
To consider the impact of lessons learned from imaging on the recurrence rate of angiofibroma.
Material And Methods:
From a cohort of 90 male patients with histologically proven angiofibroma, 40 individuals were studied. The recurrence rate in 20 cases treated before March 1998 was compared with that in 19 cases treated thereafter. In the latter group, an additional exploration of the basisphenoid had been undertaken.
Results:
The two cohorts were comparable in age range (7-27 y and 11-24 years, respectively), and all had been treated by midfacial degloving. In the first group, 8 recurrences occurred which were multiple in 1 patient. In the next 19 patients, the area of the pterygoid canal was meticulously explored and the basisphenoid drilled to remove all residual tumor. No recurrences have occurred in this group during a follow-up of between 6 months to 3 years.
Conclusion:
Meticulous removal of angiofibroma infiltrating the pterygoid canal and basisphenoid is paramount to avoid "recurrence."