Huge lobulated juvenile angiofibroma: sites of extension and selection of procedures for management.

Abstract

To review and report our experiences in the management of huge lobulated juvenile angiofibroma (JNA). From 1980 to 2001, 11 cases were diagnosed and treated in our department. Their clinical manifestations and the results of treatment were analyzed and evaluated, with particular attention to the anatomic sites of extension and the selection of choices for appropriate treatment. Owing to extranasopharyngeal extension, 6 to 12 different anatomic sites were occupied by each tumour, including the cheek (9 tumours) and middle cranial fossa (3 tumours). To remove these tumours, a transantral approach via midfacial degloving was usually used, with or without another incision and approach combined. When the middle cranial fossa is extensively involved by a tumour lobe, it should first be exposed and managed through a transtemporal-extradural or intradural approach. The internal carotid artery and cavernous sinus can be controlled distally. JNAs in 9 cases were resected completely without recurrence after following up for 1 to 22 years. The other 2 JNAs with large intracranial extension and serious intraoperative bleeding were removed subtotally. A huge JNA might occupy multiple anatomic sites, and the transantral approach via midfacial degloving is recommended as the best choice for its removal, with another incision and approach combined, if necessary.