Surgical management of juvenile nasopharyngeal angiofibroma: analysis of 162 cases from 1995 to 2012.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to report on a series of 162 patients presenting with juvenile nasopharyngeal angiofibroma in a single academic hospital during the past 17 years, in an effort to compare outcomes between open and transnasal endoscopic approach, and to define an ideal treatment strategy. STUDY DESIGN: Patients who received either open or endoscopic surgery with a minimum follow-up of 6 months were selected. Local control and complications were compared between groups. METHODS: Retrospectively, clinical data, surgical reports, pre- and postoperative images, and follow-up information were reviewed and analyzed. RESULTS: All patients were male subjects from 8 to 41 years old. Ninety-six patients were treated by transpalatal or transmaxillary approach, and the remaining 66 patients were treated using transnasal endoscopic approach with/without labiogingival incision. When compared to the open surgery group, the endoscopic surgery group showed a lower median intraoperative blood loss (800 vs. 1100 mL, P = .017) and a lower number of postoperative complications (one vs. 10). In addition, recurrence statistically correlated with Radkowski's classification and patient age. CONCLUSIONS: Transnasal endoscopic approach can be successfully used for Radkowski's stages I-IIb tumors and selective IIc-IIIb lesions, allowing for less blood loss, fewer postoperative complications, and a lower percentage of recurrence in comparison to open surgery. The management of recurrent tumor is complex, should be individually tailored, and should take into account tumor location, patient age, complications of treatment, and the possibility of spontaneous involution, to better define treatment strategy.