Nasopharyngeal angiofibromas: staging and management

We propose a system for staging nasopharyngeal angiofibromas based on clinical evaluation and computerized tomography. Twenty-three patients with this pathologic diagnosis have been managed at the University of Miami/Jackson Memorial Medical Center in the past two decades. In 13 patients, the clinical diagnosis was confirmed by transnasal biopsy as a minor outpatient procedure. This avoided unnecessary diagnostic studies, shortened the hospital stay, and expedited treatment. Computerized tomography has replaced conventional x-ray studies and routine tomography, although angiography is still necessary for proper evaluation of larger tumors. Stage groupings recommended on the basis of this experience are stage I--tumor confined to nasopharynx; stage II--tumor extending into nasal cavity and/or sphenoid sinus; stage III--tumor extending into one or more of the following: antrum, ethmoid sinus, pterygomaxillary and infratemporal fossae, orbit, and/or cheek; and stage IV--tumor extending into cranial cavity. Surgical excision is recommended for stages I, II, and III. Stage IV tumors require surgical resection and/or radiation therapy with the possible addition of hormonal therapy.