Transoral "adenoidectomy" excision of juvenile nasopharyngeal angiofibromas

Objectives: We describe a minimally invasive technique for excision of selected juvenile nasopharyngeal angiofibromas (JNAs) using indirect visualization of the nasopharynx. Methods: An observational case series with follow-up of 9 months to 3 years was performed. The subjects included 4 teenage boys with early-stage nasopharyngeal angiofibromas. The intervention included computed tomography, magnetic resonance imaging, angiography and embolization, tumor excision, pathologic examination, and follow-up. The outcome measures included blood loss, perioperative morbidity, and surgical cure. Results: Four teenage boys underwent excision of early stage JNAs - 3 with preoperative embolization. The JNAs were excised under indirect mirror guidance with an adenoid curette and the nasopharynx packed. Residual tumor was removed endoscopically. The operative time was less than I hour in each case, and blood loss was less than 100 mL. All 4 boys are free of disease. Conclusions: With the advent of refined imaging techniques and relatively safe preoperative embolization, minimally invasive approaches to JNA excision have been advocated. Endoscopic transnasal piecemeal excision is feasible but time-consuming. Transoral avulsion of the tumor mass by adenoidectomy techniques combined with endoscopic removal of tumor remnants from the pterygopalatine fossa allows complete, controlled surgical excision with minimal blood loss.