An Outcome Review of the Surgical Management of Juvenile Nasopharyngeal Angiofibroma (JNA)

Objective: To review endoscopic and open approaches in the surgical treatment of juvenile nasopharyngeal angiofibromas (JNA).

Design: Retrospective observational study.

Material and Methods: Fifty-two patients with JNA underwent treatment in our institute during a period of 4 years. The parameters studied were intraoperative blood loss, length of hospital stay, complications, the effectiveness of embolization, and recurrence. All patients were followed up for 1 year.

Results: Forty-four of the 52 patients were per primum, and eight patients had previously undergone surgery for JNA. Of the 52 patients, 3 were classified as stage I (Andrew–Fisch classification), 21 as stage II, 21 as stage IIIA, and 7 as stage IIIB. Preoperative embolization was carried out in 26 patients. In endoscopically treated patients, the mean blood loss was less (488 vs. 910 mL), duration of hospital stay was shorter (5.2 vs. 7.7 days), and the recurrence rate was lower (7.1% vs. 25%) compared with the open approach. The average blood loss was reduced in preoperatively embolized patients (593.5 vs. 761.8 mL). Overall recurrence rate was 5.76%, of which one was seen in a patient treated with the endoscopic approach and two with an open approach. Special measures like drilling the pterygoid base, sphenoid floor, and clivus helped reduce the recurrence rate.

Conclusions: The endoscopic approach is effective for stages I, II, and selected stage IIIA cases. Careful planning and few modifications can give good and acceptable cosmetic results with an open approach for advanced lesions. Nevertheless, the choice of approach should be based on disease extent, surgical expertise, and available infrastructure.