Temporal approach for resection of juvenile nasopharyngeal angiofibromas.
OBJECTIVE: To describe a lateral preauricular temporal approach for resection of juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN: A retrospective review of five patients with JNA tumors that were resected by a lateral preauricular temporal approach. METHODS: The medical records of five patients who underwent resection of JNA tumors via a lateral preauricular temporal approach were reviewed, and the following data collected: tumor extent, blood loss, hospital stay, and surgical complications. RESULTS: Five patients with JNA tumors had resection by a lateral preauricular temporal approach. These tumors ranged from relatively limited disease to more extensive intracranial, extradural tumors. Using the staging system advocated by Andrews et al., these tumors included stages II, IIIa, and IIIb. Four patients (stages II, IIIa, IIIa, and IIIb) who underwent primary surgical excision had minimal blood losses and were discharged on the first or third postoperative day with minimal transient complications (mild trismus, frontal branch paresis, serous effusion, and cheek hypesthesia). The remaining patient (stage IIIb) did well after surgery, despite having undergone preoperative radiation therapy and sustaining a significant intraoperative blood loss. There have been no permanent complications or tumor recurrences. CONCLUSIONS: A lateral preauricular temporal approach to the nasopharynx and infratemporal fossa provides effective exposure for resection of extradural JNA tumors. The advantages of this approach include a straightforward route to the site of origin, the absence of facial and palatal incisions, and avoidance of a permanent ipsilateral conductive hearing loss.