Juvenile nasopharyngeal angiofibroma: comparison between endoscopic and open operative approaches

Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular and fibrous tumor that most commonly affects males in prepuberal and adolescent age. Traditionally, these tumors have been removed, after selective embolization, with the open surgical approach (degloving), but the interest in the endoscopic resection, especially for small tumors, has increased in recent years. To present our experience of JNA management, comparing the endoscopic approach and open/combined approach.

We conducted a retrospective, cross-sectional, and descriptive study of 12 young men, ages between 9 and 19 years (mean: 13), suffering from nasopharyngeal angiofibroma and treated with open surgery (N = 6), with endoscopic excision (N = 5) or with combined approach (N = 1). We reviewed demographical data, clinical presentation, surgical approach as well as time of surgery, of hospitalization, need of blood transfusion during surgery, and complications occurred during hospitalization.

All JNA patients were male. The average age at diagnosis was 13.7 years (range 9-19 years). Approximately, 8.3% were classified as Önerci I, 41.7% as Önerci II, and 50.0% as Önerci III. Preoperative embolization was carried out in all patients. All patients were submitted to primary surgical resection, and 2 of them required intraoperative blood transfusion. The overall recurrence rate was 8.3% and the cure rate was 100%.

This study confirmed that endoscopic approach gives excellent results in small and medium dimensions tumors, whereas open surgery remains a safe procedure for patients with larger tumors.