Juvenile Nasopharyngeal Angiofibroma - Revision history

AlexHarris at 01:31, 3 February 2026

2026-02-03T01:31:22Z

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AlexHarris at 01:17, 3 February 2026

2026-02-03T01:17:04Z

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Jack.Dewey: /* Surgical Management */

2025-08-16T18:46:50Z

Surgical Management

← Older revision		Revision as of 18:46, 16 August 2025
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	=== Surgical Management ===		=== Surgical Management ===
	Historically, surgical management of JNAs involved aggressive open approaches, including transpalatal, lateral rhinotomy, midface degloving, or infratemporal fossa craniotomy approaches.<ref name="Renkonen 2011">Renkonen S, Hagström J, Vuola J, Niemelä M, Porras M, Kivivuori SM, Leivo I, Mäkitie AA. The changing surgical management of juvenile nasopharyngeal angiofibroma. European archives of oto-rhino-laryngology. 2011 Apr;268:599-607. https://doi.org/10.1007/s00405-010-1383-z</ref> In recent years, there has been a transition towards transnasal endoscopic approaches. This has resulted in better visualization during surgery and a subsequent improvement in intraoperative blood loss, need for blood transfusions,<ref name="Oliveira 2012">Oliveira JA, Tavares MG, Aguiar CV, Azevedo JF, Sousa JR, Almeida PC, Gomes EF. Comparison between endoscopic and open surgery in 37 patients with nasopharyngeal angiofibroma. Brazilian Journal of otorhinolaryngology. 2012;78:75-80. https://doi.org/10.1590/S1808-86942012000100012</ref> and recurrence rates.<ref name="Bosraty 2011">Bosraty H, Atef A, Aziz M. Endoscopic vs. open surgery for treating large, locally advanced juvenile angiofibromas: A comparison of local control and morbidity outcomes. ENT: Ear, Nose & Throat Journal. 2011 Nov 1;90(11). PMID: 22109921</ref> Prior to surgery, preoperative embolization should be considered to limit blood loss intraoperatively.		Historically, surgical management of JNAs involved aggressive open approaches, including transpalatal, lateral rhinotomy, midface degloving, or infratemporal fossa craniotomy approaches.<ref name="Renkonen 2011">Renkonen S, Hagström J, Vuola J, Niemelä M, Porras M, Kivivuori SM, Leivo I, Mäkitie AA. The changing surgical management of juvenile nasopharyngeal angiofibroma. European archives of oto-rhino-laryngology. 2011 Apr;268:599-607. https://doi.org/10.1007/s00405-010-1383-z</ref> In recent years, there has been a transition towards transnasal endoscopic approaches. This has resulted in better visualization during surgery and a subsequent improvement in intraoperative blood loss, need for blood transfusions,<ref name="Oliveira 2012">Oliveira JA, Tavares MG, Aguiar CV, Azevedo JF, Sousa JR, Almeida PC, Gomes EF. Comparison between endoscopic and open surgery in 37 patients with nasopharyngeal angiofibroma. Brazilian Journal of otorhinolaryngology. 2012;78:75-80. https://doi.org/10.1590/S1808-86942012000100012</ref> and recurrence rates.<ref name="Bosraty 2011">Bosraty H, Atef A, Aziz M. Endoscopic vs. open surgery for treating large, locally advanced juvenile angiofibromas: A comparison of local control and morbidity outcomes. ENT: Ear, Nose & Throat Journal. 2011 Nov 1;90(11). PMID: 22109921</ref> Prior to surgery, preoperative embolization should be considered to limit blood loss intraoperatively.

			An example of a combined endoscopic transnasal and trans-maxillary (Caldwell-Luc) approach can be seen here:
			https://www.youtube.com/watch?v=gYX6NgjAj5Q

	== Outcomes ==		== Outcomes ==

Jack.Dewey at 21:04, 18 November 2024

2024-11-18T21:04:22Z

← Older revision		Revision as of 21:04, 18 November 2024
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	==== Recurrence ====		==== Recurrence ====
	Recurrence rates are similarly related to surgical technique and tumor stage. Endoscopic approaches have been documented to have an improved recurrence rate relative to open approaches.<ref name="Bosraty 2011"></ref> A systematic review of 92 studies totaling 821 patients found a recurrence rate of about 10% ~~and~~ 7.7% with residual tumor.~~***~~ Studies looking at more invasive tumors have a higher rate of recurrence		Recurrence rates are similarly related to surgical technique and tumor stage. Endoscopic approaches have been documented to have an improved recurrence rate relative to open approaches.<ref name="Bosraty 2011"></ref> A systematic review of 92 studies totaling 821 patients found a recurrence rate of about 10%, as well as 7.7% with residual tumor.<ref name="Khoueir 2013">Khoueir N, Nicolas N, Rohayem Z, Haddad A, Abou Hamad W. Exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma: a systematic review of the literature. Otolaryngology–Head and Neck Surgery. 2014 Mar;150(3):350-8. https://doi.org/10.1177/0194599813516605</ref> Studies looking at more invasive tumors have a higher rate of recurrence of approximately 18%.<ref name="Leong 2013"></ref>

	=== Prognosis ===		=== Prognosis ===

Jack.Dewey at 16:29, 18 November 2024

2024-11-18T16:29:17Z

← Older revision		Revision as of 16:29, 18 November 2024
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	==== Recurrence ====		==== Recurrence ====
			Recurrence rates are similarly related to surgical technique and tumor stage. Endoscopic approaches have been documented to have an improved recurrence rate relative to open approaches.<ref name="Bosraty 2011"></ref> A systematic review of 92 studies totaling 821 patients found a recurrence rate of about 10% and 7.7% with residual tumor.*** Studies looking at more invasive tumors have a higher rate of recurrence

	=== Prognosis ===		=== Prognosis ===

Jack.Dewey at 16:20, 18 November 2024

2024-11-18T16:20:03Z

← Older revision		Revision as of 16:20, 18 November 2024
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	== Outcomes ==		== Outcomes ==
	=== Complications ===		=== Complications ===
			The primary concerns in the surgical management of juvenile nasopharyngeal angiofibroma are bleeding and recurrence rates. Iatrogenic injuries to structures of the orbit (such as ophthalmoplegia) and skull base (such as facial paresthesias) are also a concern depending on the degree of tumor extension.

			==== Bleeding ====
			Intraoperative bleeding rates vary based on technique, whether preoperative embolization was used, and tumor staging. Endoscopic surgery is generally accepted to have lower intraoperative blood loss relative to more traditional open approaches.<ref name="Oliveira 2012"></ref> Preoperative embolization has also been found to significantly lower intraoperative blood loss. One study of 47 patients (primarily Radkowski stages I-II) found that patients who underwent preoperative embolization had a mean estimated blood loss (EBL) of 770 mL, and patients who did not undergo embolization had a mean EBL of more than 1,400 mL.<ref name="Ardehali 2010">Ardehali MM, Ardestani SH, Yazdani N, Goodarzi H, Bastaninejad S. Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma: complications and outcomes. American journal of otolaryngology. 2010 Sep 1;31(5):343-9. https://doi.org/10.1016/j.amjoto.2009.04.007</ref> The same study noted that embolized patients had a mean hospital stay of 1.8 days, vs 3.1 days for all patients in the study. A systematic review of advance-stage JNAs with intracranial extension found a mean EBL of 1,700 mL and a similar reduction in EBL following preoperative embolization.<ref name="Leong 2013">Leong SC. A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement. The Laryngoscope. 2013 May;123(5):1125-31. https://doi.org/10.1002/lary.23760</ref>

			==== Recurrence ====


	=== Prognosis ===		=== Prognosis ===
	Recurrence rates can be very high and increase with increased stage at the time of surgery. Recurrence has been reported from 22%<ref name="Bleier 2009">Bleier BS, Kennedy DW, Palmer JN, Chiu AG, Bloom JD, O'Malley Jr BW. Current management of juvenile nasopharyngeal angiofibroma: a tertiary center experience 1999–2007. American journal of rhinology & allergy. 2009 May;23(3):328-30. https://doi.org/10.2500/ajra.2009.23.3322</ref> to as high as 61% in advanced disease.<ref name="Huang 2014">Huang Y, Liu Z, Wang J, Sun X, Yang L, Wang D. Surgical management of juvenile nasopharyngeal angiofibroma: analysis of 162 cases from 1995 to 2012. The Laryngoscope. 2014 Aug;124(8):1942-6. https://doi.org/10.1002/lary.24522</ref>		Recurrence rates can be very high and increase with increased stage at the time of surgery. Recurrence has been reported from 22%<ref name="Bleier 2009">Bleier BS, Kennedy DW, Palmer JN, Chiu AG, Bloom JD, O'Malley Jr BW. Current management of juvenile nasopharyngeal angiofibroma: a tertiary center experience 1999–2007. American journal of rhinology & allergy. 2009 May;23(3):328-30. https://doi.org/10.2500/ajra.2009.23.3322</ref> to as high as 61% in advanced disease.<ref name="Huang 2014">Huang Y, Liu Z, Wang J, Sun X, Yang L, Wang D. Surgical management of juvenile nasopharyngeal angiofibroma: analysis of 162 cases from 1995 to 2012. The Laryngoscope. 2014 Aug;124(8):1942-6. https://doi.org/10.1002/lary.24522</ref>

Jack.Dewey: /* Prognosis */

2024-11-17T21:47:09Z

Prognosis

← Older revision		Revision as of 21:47, 17 November 2024
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	=== Complications ===		=== Complications ===
	=== Prognosis ===		=== Prognosis ===
	Recurrence rates can be very high and increase with increased stage at the time of surgery. Recurrence has been reported from 22%<ref name="Bleier 2009">Bleier BS, Kennedy DW, Palmer JN, Chiu AG, Bloom JD, O'Malley Jr BW. Current management of juvenile nasopharyngeal angiofibroma: a tertiary center experience 1999–2007. American journal of rhinology & allergy. 2009 May;23(3):328-30. https://doi.org/10.2500/ajra.2009.23.3322</ref> to as high as 61% in advanced disease.<ref name="Huang ~~2013~~"></ref>		Recurrence rates can be very high and increase with increased stage at the time of surgery. Recurrence has been reported from 22%<ref name="Bleier 2009">Bleier BS, Kennedy DW, Palmer JN, Chiu AG, Bloom JD, O'Malley Jr BW. Current management of juvenile nasopharyngeal angiofibroma: a tertiary center experience 1999–2007. American journal of rhinology & allergy. 2009 May;23(3):328-30. https://doi.org/10.2500/ajra.2009.23.3322</ref> to as high as 61% in advanced disease.<ref name="Huang 2014">Huang Y, Liu Z, Wang J, Sun X, Yang L, Wang D. Surgical management of juvenile nasopharyngeal angiofibroma: analysis of 162 cases from 1995 to 2012. The Laryngoscope. 2014 Aug;124(8):1942-6. https://doi.org/10.1002/lary.24522</ref>

	== References ==		== References ==
	<references />		<references />

Jack.Dewey: /* Prognosis */

2024-11-17T21:46:07Z

Prognosis

← Older revision		Revision as of 21:46, 17 November 2024
Line 124:		Line 124:
	=== Complications ===		=== Complications ===
	=== Prognosis ===		=== Prognosis ===
	Recurrence rates can be very high and increase with increased stage at the time of surgery. Recurrence has been reported from 22%<ref name="Bleier 2009">Bleier BS, Kennedy DW, Palmer JN, Chiu AG, Bloom JD, O'Malley Jr BW. Current management of juvenile nasopharyngeal angiofibroma: a tertiary center experience 1999–2007. American journal of rhinology & allergy. 2009 May;23(3):328-30. https://doi.org/10.2500/ajra.2009.23.3322</ref> to as high as 50% in advanced disease.<ref name="~~Onerci 2003~~">Önerci TM, Yücel ÖT, Öğretmenoğlu O. Endoscopic surgery in treatment of juvenile nasopharyngeal angiofibroma. International journal of pediatric otorhinolaryngology. 2003 Nov 1;67(11):1219-25. https://doi.org/10.1016/j.ijporl.2003.07.013</ref>		Recurrence rates can be very high and increase with increased stage at the time of surgery. Recurrence has been reported from 22%<ref name="Bleier 2009">Bleier BS, Kennedy DW, Palmer JN, Chiu AG, Bloom JD, O'Malley Jr BW. Current management of juvenile nasopharyngeal angiofibroma: a tertiary center experience 1999–2007. American journal of rhinology & allergy. 2009 May;23(3):328-30. https://doi.org/10.2500/ajra.2009.23.3322</ref> to as high as 61% in advanced disease.<ref name="Huang 2013"></ref>

	== References ==		== References ==
	<references />		<references />

Jack.Dewey: /* Prognosis */

2024-11-17T21:43:31Z

Prognosis

← Older revision		Revision as of 21:43, 17 November 2024
Line 124:		Line 124:
	=== Complications ===		=== Complications ===
	=== Prognosis ===		=== Prognosis ===
			Recurrence rates can be very high and increase with increased stage at the time of surgery. Recurrence has been reported from 22%<ref name="Bleier 2009">Bleier BS, Kennedy DW, Palmer JN, Chiu AG, Bloom JD, O'Malley Jr BW. Current management of juvenile nasopharyngeal angiofibroma: a tertiary center experience 1999–2007. American journal of rhinology & allergy. 2009 May;23(3):328-30. https://doi.org/10.2500/ajra.2009.23.3322</ref> to as high as 50% in advanced disease.<ref name="Onerci 2003">Önerci TM, Yücel ÖT, Öğretmenoğlu O. Endoscopic surgery in treatment of juvenile nasopharyngeal angiofibroma. International journal of pediatric otorhinolaryngology. 2003 Nov 1;67(11):1219-25. https://doi.org/10.1016/j.ijporl.2003.07.013</ref>

	== References ==		== References ==
	<references />		<references />

Jack.Dewey: /* Surgical Management */

2024-11-17T21:30:06Z

Surgical Management

← Older revision		Revision as of 21:30, 17 November 2024
Line 119:		Line 119:

	=== Surgical Management ===		=== Surgical Management ===
	Historically, surgical management of JNAs involved aggressive open approaches, including transpalatal, lateral rhinotomy, midface degloving, or infratemporal fossa craniotomy approaches.<ref name="Renkonen 2011">Renkonen S, Hagström J, Vuola J, Niemelä M, Porras M, Kivivuori SM, Leivo I, Mäkitie AA. The changing surgical management of juvenile nasopharyngeal angiofibroma. European archives of oto-rhino-laryngology. 2011 Apr;268:599-607. https://doi.org/10.1007/s00405-010-1383-z</ref> In recent years, there has been a transition towards transnasal endoscopic approaches. This has resulted in better visualization during surgery and a subsequent improvement in intraoperative blood loss, need for blood transfusions,<ref name="Oliveira 2012">Oliveira JA, Tavares MG, Aguiar CV, Azevedo JF, Sousa JR, Almeida PC, Gomes EF. Comparison between endoscopic and open surgery in 37 patients with nasopharyngeal angiofibroma. Brazilian Journal of otorhinolaryngology. 2012;78:75-80. https://doi.org/10.1590/S1808-86942012000100012</ref> and recurrence rates.<ref name="Bosraty 2011">Bosraty H, Atef A, Aziz M. Endoscopic vs. open surgery for treating large, locally advanced juvenile angiofibromas: A comparison of local control and morbidity outcomes. ENT: Ear, Nose & Throat Journal. 2011 Nov 1;90(11). PMID: 22109921</ref>		Historically, surgical management of JNAs involved aggressive open approaches, including transpalatal, lateral rhinotomy, midface degloving, or infratemporal fossa craniotomy approaches.<ref name="Renkonen 2011">Renkonen S, Hagström J, Vuola J, Niemelä M, Porras M, Kivivuori SM, Leivo I, Mäkitie AA. The changing surgical management of juvenile nasopharyngeal angiofibroma. European archives of oto-rhino-laryngology. 2011 Apr;268:599-607. https://doi.org/10.1007/s00405-010-1383-z</ref> In recent years, there has been a transition towards transnasal endoscopic approaches. This has resulted in better visualization during surgery and a subsequent improvement in intraoperative blood loss, need for blood transfusions,<ref name="Oliveira 2012">Oliveira JA, Tavares MG, Aguiar CV, Azevedo JF, Sousa JR, Almeida PC, Gomes EF. Comparison between endoscopic and open surgery in 37 patients with nasopharyngeal angiofibroma. Brazilian Journal of otorhinolaryngology. 2012;78:75-80. https://doi.org/10.1590/S1808-86942012000100012</ref> and recurrence rates.<ref name="Bosraty 2011">Bosraty H, Atef A, Aziz M. Endoscopic vs. open surgery for treating large, locally advanced juvenile angiofibromas: A comparison of local control and morbidity outcomes. ENT: Ear, Nose & Throat Journal. 2011 Nov 1;90(11). PMID: 22109921</ref> Prior to surgery, preoperative embolization should be considered to limit blood loss intraoperatively.

	== Outcomes ==		== Outcomes ==