[Nasopharyngeal fibroma. Forms extended to the infratemporal fossa]

There are two clinicopathologic forms of nasopharyngeal fibroma: a median, compact form for which surgical treatment is simple, and a racemose, pedicled form raising problems for exeresis due to its extensions into the infratemporal fossa and the middle cranial fossa. A 4-stage grading is essential, and it has become easier with the progress made by imaging. The clinical findings, the contribution of imaging and the surgical procedures are studied for stages III and IV. Statistics are presented for 26 nasopharyngeal fibromas, including 10 invasive forms. Two approaches of the infratemporal fossa have been used in this series; the PLN approach with a large fronto-naso-maxillary flap, and the pre-auricular infratemporal lateral approach. The exeresis of stage III lesions requires the lateral approach.