S280 – Current Management of Juvenile Nasopharyngeal Angiofibroma

Abstract

Objectives

To report on the management of a large series of patients presenting with juvenile nasopharyngeal angiofibroma (JNA) in an effort to further define the optimal treatment algorithm in this patient population.

Methods

Retrospective, IRB approved, review of 18 patients presenting to a tertiary care institution with histologically confirmed juvenile nasopharyngeal angiofibroma between 1999 and 2007, with a mean follow-up of 732 days. Patients were catagorized by Andrews stage and data was collected on presentation, operative technique, and postoperative course.

Results

All patients underwent preoperative embolization. Stage 1, 2, and one 3a lesions were approached endoscopically, while the remainder underwent open resection. There were no significant differences in mean operative time between the endoscopic and open groups (312 vs. 365 minutes). In the endoscopic group, the intraoperative blood loss was almost half that of the open group (506 vs. 934cc) and the average length of hospital stay was 1 day less (3 vs. 4 days). There were 4 recurrences, all of which occurred in the open treatment group.

Conclusions

Endoscopic resection is reasonable for Andrews stage 1, 2, and select 3a lesions and may allow for less bleeding and shorter hospital stay. This study supports the current trend of expansion of indications for endoscopic JNA resection and suggests that this approach leads to an improved postoperative course.