Treatment outcomes of juvenile nasopharyngeal angiofibroma according to stage and surgical approach

Abstract

[한글]

[영문]Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasopharynx, and for its treatment, many surgical approaches have been suggested. However, selecting the appropriate one for the tumor in an advanced stage is still controversial. This is a retrospective study that aimed to assess the treatment outcomes according to stage and surgical approach in juvenile nasopharyngeal angiofibroma (JNA). A retrospective review of JNA patients treated at our institution resulted in the identification of 20 patients with JNA with a Radkowski stage greater than I and a minimum follow-up of 10 months. All 20 JNA patients were male and the median age at diagnosis was 15.5 years. Using Radkowski staging, six patients were in stage IIa, three patients were in stage IIb, eight patients were in stage IIc, two patients were in stage IIIa, and one patient was in stage IIIb. Seven of 20 patients were treated surgically for recurrence or a remnant tumor after the initial operation and the mean interval to recurrence was 15.5 months. Recurrence or remnant tumors were most commonly observed in patients with stage IIc tumors (50.0%) compared to other stages (33.3%, 33.3% and 0% for stages IIa, IIb, and IIIa/IIIb, respectively). An endoscopic approach was chosen in four patients, with a recurrence rate of 25.0% but the tumors of stage IIa and IIb were completely controlled by endoscopic surgery. A midfacial degloving approach (MFDA) was used in seven patients, with a recurrence rate of 42.9%. The maxillary swing approach was taken in three patients, with complete control. Postoperative complications that required intervention occurred in 14.8% of cases, especially when the maxillary swing or infratemporal fossa approaches were used. Therefore, the modality of a surgical treatment of JNA should be selected based on the ability to achieve complete resection of tumor and possible complications. In conclusion, whether an minimally invasive approach including endoscopic approach and MFDA or a relatively invasive approach including maxillary swing and infratemporal fossa approach should be used for Stage IIc is equivocal. However, considering possible postoperative complications, we recommend using an endoscopic approach or midfacial degloving approach for stage IIc initially. Furthermore, recurrent stage IIc or stage III should be managed by a maxillary swing or infratemporal fossa approach despite the postoperative complications associated with these approaches.