[Extra-nasopharyngeal extensions of angiofibroma]

Four cases of NPA with extra-nasopharyngeal extensions have been presented, two of which had an intracranial extension. On of the cases with intracranial extension underwent a transtemporal craniotomy removal and four temporal fossa. The other three cases were managed by the sublabial and transantral routes. Methods of pre-operative diagnosis of such extensions have been discussed and the importance of pre-operative recognition of extension in every NPA has been emphasized. Various approaches to the lateral and intracranial extensions have been reviewed. We feel that, for lateral extensions, sublabial and/or transantral or transzygomatic approaches are adequate, while the radical approach of Karnik is to be preferred only in large lateral extensions and in cases of intracranial extensions without symptoms of a space-occupying intracranial lesion. However, for patients with intracranial symptoms, a staged procedure is indicated and is safe for the patient.