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Article Published In Vol.4 (Sept-Oct-2016)

Outcome of Midface Degloving Approach in the management of Juvenile Nasopharyngeal Angiofibroma

Author : Hazim Mohammed Khudhair FICMS(ENT), CABS(ORL-HNS), Laith Hayder M. Ali, MB.ChB.,DLO, Mukhallad Mahdi Saleh, FICMS and Maha Faeq Majeed FICMS

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Back ground: Juvenile nasopharyngeal angiofibroma is highly vascular tumor affecting predominantly young males. It arises from the nasopharynx. There are many procedures for treating such vascular tumor; midface degloving is one of surgical modalities of treatment.
Objective: Evaluation of outcome of 10 patients with juvenile nasopharyngeal angiofibroma treated by midface degloving approach, regarding complications, blood loss and rate of recurrence.
Design: A cross sectional study.
Setting: Department of Otolaryngology & Head and Neck Surgery, Ghazi Al-Hariri Surgical Specialties Hospital, Medical City Complex, Baghdad.
Patients and Method: This study included 10 consecutive case series of juvenile nasopharyngeal angiofibroma over a period of 3 years from 2010-2013. All patients were admitted to our ENT department. Detailed history, clinical examination and relevant investigations were done. Imaging including contrast-enhanced CT scan with MRI was done to all cases. All the patients had undergone surgical excision through midface degloving approach. Patients were regularly followed-up for any recurrence and complications for 3 years period.
Results: All patients were males and the average age at the diagnosis was 18.2 years (range 12-27 years). Nasal obstruction and recurrent epistaxis were the presenting complaints in all cases. None of the tumors were embolized prior to surgery. The overall recurrence was 10%. Majority of our patients had stage I, II, III (according to Fisch classification).
Conclusion: Juvenile nasopharyngeal angiofibroma is a highly vascular tumor of adolescent boys can be surgically excised through midface degloving approach that permit removal of tumor in toto by dissection in sub-periosteal plane and drilling the nests of tumor in basi-sphenoid and medial pterygoid plate which is mandatory to excise any residual disease and prevent recurrence of tumor.

Keywords: Midface Degloving Approach, Juvenile nasopharyngeal angiofibroma

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