Juvenile angiofibroma and its management

This prospective longitudinal study was done to determine extent of tumor and to highlight the importance of lateral rhinotomy approach for nasopharyngeal angiofibroma. Patients with a diagnosis of nasopharyngeal angiofibroma who underwent surgery in Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu from April, 2004 to Jan 2009 were included in the study. Extent of tumour and surgical approaches were noted in a special form prepared for the study. Fisch Staging system was followed for the extent of tumor. A total number of patients were 23 and all of them were male. Age ranged from 15-30 years with mean age of 18.25 years. All the patients underwent contrast enhanced CTScan. Two patients had stage I tumor, 9 patients had stage II disease, other 12 patients had stage III tumor. Twenty patients were operated by lateral rhinotomy approach. In one patient with the tumour hanging in the oropharynx with a pedical attached to the lateral wall of nasopharynx was removed by peroral route and in another patient with tumour confined to nasopharynx and posterior part of nose was removed by transpalatal approach. One patient who had tumour extention into infratemporal fossa were operated by lateral rhinotomy with inferior sublabial extetention approach. Eleven patients underwent preoperative embolization with gelfoam 48 hours prior to surgery. Most of them had stage III disease and were managed surgically by lateral rhinotomy approach. Lateral rhinotomy approach with or without extention of incision can be used to remove tumours in majority of patients.