Surgical treatment of juvenile nasopharyngeal angiofibroma

Twenty‐five cases of juvenile nasopharyngeal angiofibroma are reviewed. Surgical removal via a transpalatal approach accompanied by a gingivobuccal incision and exploration of the pterygomaxillary space to remove lateral extension is advocated. This procedure is almost uniformly successful in eradicating tumors without intracranial extension. Pre‐operative estrogen therapy and temporary ligation of the ipsilateral carotid artery in selected cases appears to decrease blood loss at surgery. Pre‐operative angiography delineates the nasopharyngeal mass, shows any pterygomaxillary space extension, and demonstrates any middle cranial fossa extension. A fairly accurate estimate of the percentages of vascular contribution is also obtained, allowing the surgeon to plan possible vascular control by ligation. Intracranial fossa extension generally greatly increases the operative blood loss and risk, because of probable subtotal resection but is not an absolute contraindication to surgery.