Management of nasopharyngeal angiofibroma

Successful surgical treatment of nasopharyngeal angiofibroma requires complete pre-operative evaluation and careful choice of a suitable surgical approach. Experience with 12 patients presenting with this tumor demonstrates the value of polytomography and angiography in evaluation. The use of pre-operative estrogens and temporary vessel ligation has decreased blood loss. The surgical approach is modified depending upon tumor location. A tumor confined to the nasopharynx is removed by a transpalatal approach. Extension into the sinuses or orbit necessitates a sublabial incision or lateral rhinotomy. Pterygo-maxillary tumor may be exposed by extension of the sublabial incision posterior to the maxillary tuberosity. This allows one to push the tumor back into the nasopharynx. Intracranial extension is removed by a combined otolaryngologic-neurosurgical approach.