Endoscopic-assisted midfacial degloving approach for type III juvenile angiofibroma.

Background: Open surgery is the mainstay treatment for juvenile angiofibromas (JAF). Midfacial degloving approach provides good exposure to the target area with excellent cosmoses. Endoscopic techniques have been used for the removal of some small JAF.

Objectives/hypothesis: To evaluate the efficacy and outcome of endoscopic-assisted midfacial degloving approach as a route for removal of type III juvenile angiofibroma.

Patients And Methods: Fifteen young male patients with type III JAF (based on Fisch classification by computed tomography (CT) and magnetic resonance imaging (MRI) or both), were operated on by endoscopic-assisted midfacial degloving approach. Pre-operative angiography and embolization were performed in two patients. The surgical technique is described in details.

Results: Apart from a case developed cerebrospinal fluid (CSF) rhinorrhea intraoperatively there were neither major operative nor post-operative complications. CSF leak was repaired through the same approach successfully in the same set. Thirteen patients had complete tumor clearance with no residual or recurrence during the follow-up period which ranged from 6 months to 6 years. Recurrence was detected early by endoscopic examination in two cases (3 and 8 months post-operatively) and confirmed by CT and MRI. Endoscopic transnasal removal of the recurrent JAF was done successfully under local anesthesia in the first patient and under general anesthesia in the second with no recurrence during the follow-up period.

Conclusions: Endoscopic-assisted midfacial degloving approach for removal of type III JAF enables the surgeon to gain the advantages of midfacial degloving approach with extensive exposure of the surgical field. Employing an endoscope, offers safe dealing with serious intraoperative complications like CSF leak. Post-operative follow-up by endoscopic nasal examination can detect early recurrence, which can be confirmed by CT and MRI.