Practice Essentials
Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor that tends to bleed and occurs in the nasopharynx of prepubertal and adolescent males.
Workup in juvenile nasopharyngeal angiofibroma
Plain radiography views of the sinuses may demonstrate nasopharyngeal polyp. Bowing of the posterior wall of the maxillary sinus and maxillary sinus opacification is very suggestive of juvenile nasopharyngeal angiofibroma (JNA). Newer radiographic modalities have surpassed plain films in usefulness.
Magnetic resonance imaging (MRI) is indicated to delineate and define the extent of the tumor, especially in cases of intracranial involvement.
Bilateral vascular supply may be an underappreciated factor in JNA, and thorough radiographic investigation via angiography of bilateral carotid systems should be routinely performed preoperatively.
Different staging systems exist for nasopharyngeal angiofibroma. The two most commonly used are those of Sessions and Fisch.
Surgical management of juvenile nasopharyngeal angiofibroma
A lateral rhinotomy, transpalatal, transmaxillary, or sphenoethmoidal route is used for small tumors (Fisch stage I or II), while the infratemporal fossa approach is used when the tumor has a large lateral extension.
The midfacial degloving approach, with or without a Le Fort osteotomy, improves posterior access to the tumor.
The facial translocation approach is combined with Weber-Ferguson incision and coronal extension for a frontotemporal craniotomy with midface osteotomies for access.
An extended anterior subcranial approach facilitates en bloc tumor removal, optic nerve decompression, and exposure of the cavernous sinus.
Some authors advocate the use of intranasal endoscopic surgery for lesions with limited extension to the infratemporal fossa.