Outcomes of endoscopic surgery, endoscopic-assisted surgery and open surgery in the treatment of juvenile nasopharyngeal angiofibroma

Introduction: The therapeutic procedures for juvenile nasopharyngeal angiofibroma (JNA) still remain a challenge. Aim: To present the outcomes of JNA treatment at the Department of Otolaryngology in Poznan, Poland, between 2000 and 2008. This study contrasts endoscopic surgery and endoscopic-assisted surgery with open surgery in cases of small and large JNA. Material and methods: We reviewed the histories of patients who were managed surgically for JNA between 2000 and 2008 at the Department of Otolaryngology in Poznan, Poland. The size of the tumour was measured prior to surgery, using contrast-enhanced computed tomography or magnetic resonance imaging. The extent of the disease was then assessed according to the staging scale proposed by Radkowski et al. Results: Fifteen patients underwent surgery for JNA. Of 8 patients with small tumours, 4 patients underwent open surgery, and 4 patients underwent endoscopic surgery. Of the remaining 7 patients with large tumours, five underwent open surgery and two of them endoscopic-assisted open surgery. In the one-year follow-up of patients who underwent endoscopic surgery exclusively or endoscopic-assisted open surgery no recurrence was found. Of the 9 patients who underwent open surgery, tumour recurrence was observed in 4 cases. Conclusions: Selection of the surgical technique in JNA depends on the extent of the tumour and the equipment available. The endoscopic technique is useful for selected small tumours and open surgery and/or endoscopicassisted open surgery is useful for large tumours. Repeat JNA surgeries may be performed using the open technique, the endoscopic technique, or the endoscopic-assisted open technique.