Juvenile nasopharyngeal angiofibroma: diagnosis and treatment.
Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon, histologically benign vascular tumor that occurs almost exclusively in adolescent males. While occasional mention is made of the occurrence of JNA in females and in older males, only four cases have withstood rigorous clinicopathological review. This neoplasm accounts for less than 0.05% of all benign lesions that originate in the nasopharynx. Its clinically malignant behavior is a result of its propensity for locally destructive growth and fatal hemorrhage. The evolution in the management of these tumors has been the subject of much interest and much confusion. The advents of computed tomographic (CT) scanning, selective angiography with embolization, and refinements in surgical approaches have revolutionized operative management of these lesions by allowing more realistic selection of surgical candidates, better preoperative planning, and more flexible (yet aggressive) primary surgical treatment. The attendant reduction in morbidity and mortality of contemporary surgical management of this disease has largely obviated the argument of those who advocate use of radiotherapy as the primary treatment modality for this benign lesion. This latter view is based on the reports of massive hemorrhage, significant incidence of incomplete removal, and mortality reported in the older surgical literature. This article details our experience with a series of 31 patients who had clinicopathological diagnoses of JNA and were treated between 1954 and 1984. It furthermore represents an update of our previously reported series.