[Clinical study of juvenile nasopharyngeal angiofibroma].

Objective: To present our experiences of diagnosis and treatment for juvenile nasopharyngeal angiofibroma (JNA) and to evaluate the factors influencing intra-operative bleeding and tumor recurrence.

Method: Forty-five patients suffered form JNA experienced surgical management and/or radiotherapy between January 1980 and December 2001 were studied retrospectively. All the patients were males. The age ranged from 13 to 24 years with mean of 16.3 years. Three operative approaches were selected according to tumor stage: the traditional and modified transpalatal, lateral rhinotomy and craniofacial combined approach. Six cases received postoperative radiotherapy and 1 case received radiotherapy without surgery.

Result: The tumors were completely resected in 36 cases and recurred in 9 cases (20%) during a follow-up period of 6-84 months. Six of the 9 recurrent tumors were completely resected and the rest 3 were incompletely resected combined with postoperative radiotherapy. No recurrence was found in a follow-up period of 1-3 years. The tumor stage influences intraoperative bleeding and the incidence of recurrence. No statistically significance difference was found when comparing preoperative embolization of the vessels and ligature of the external carotid artery patients with non-embolized and control group (P = 0.554).

Conclusion: (1) With the approaches of operation selected according to tumor stage, most of the tumors can be removed by the traditional/modified transpalatal and lateral rhinotomy approaches; (2) Preoperative ligature of the external carotid artery and embolization of the vessels feeding the tumor can not reduce intraoperative bleeding. The inconsistency of tumor staging in test and control groups may lead to this result; (3) The tumors stage influences the intraoperative bleeding and the incidence of recurrence; (4) Radiotherapy is an effective adjuvant treatment for the patients with advanced stage or recurrent tumors.