Endoscopic removal of juvenile nasopharyngeal angiofibromas: a video presentation

Juvenile nasal angiogibroma (JNA) is a relatively rare, benign neoplasm generally seen in prepubertal and adolescent males. In the past, surgical management included lateral rhinotomy, transpalatal and transmaxillary routes, and midface degloving approaches. Endoscopic approaches have become the treatment of choice, especially for tumors limited by size and location criteria. Our presentation demonstrates an endoscopic approach to excision of JNAs that are limited to the nasal cavity, nasopharynx, and paranasal sinuses. Through the use of a brief video presentation, participants will be able to visualize the endoscopic technique.

A retrospective review of JNA patients treated at our institution identified 3 patients who underwent endoscopic removal. All patients underwent preoperative embolization followed by endoscopic resection.

A video demonstration is presented of a patient with a 3.5 cm JNA who underwent successful endoscopic, endonasal excision. After medialization of the middle turbinate and anterior ethmoidectomy, the tumor could be mobilized using a Cottle elevator and microdebrider. The origin and attachment of the tumor were visualized and detached from the sphenopalatine foramen. The tumor was resected en bloc with minimal bleeding. There were no intraoperative complications, and postoperative bleeding was negligible. To date, there has been no evidence of recurrence of tumor in these individuals.

Endoscopic removal is the approach of choice for small to medium, limited-extent JNAs.