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

Abstract

Background: 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.