Surgical treatment of nasopharygeal angiofibroma

Objective: To share with others our clinical experience involving nasopharygeal angiofibroma. Materials and Methods: This study comprised nine patients with nasopharyngeal angiofibroma diagnosed and treated at National Cheng Kung University Hospital during the period from 1989 through 1998. Results: One of our cases was a rare female case with sex chromosome proof. Selective arterial embolization followed by surgical excision was performed in eight cases. The median estimated blood loss was 850 mL in the group without collateral circulation of the internal carotid artery but 3000 mL in the other group. Conventional routes of surgery were used for all the patients except one; that patient underwent transnasal endoscopy. Conclusion: Nasopharyngeal angiofibroma is an aggressively expansile vascular tumor, happening almost exclusively to pubescent males, One of the patients in our study was female with sex chromosome proof. Selective arterial embolization followed by surgical excision is the treatment of choice. Blood loss was obviously less in cases without collateral circulation of the internal carotid artery than in those with collateral circulation. The routes for removing nasopharyngeal angiofibromas documented in previous reports include lateral rhinotomy, transpalatal, sublabial degloving, transzygomatic, or combinations of these approaches. One of our patients was successfully treated using a transnasal endoscopic approach without complications. This proved that the transnasal endoscopic approach might be an alternative route for removing nasopharyngeal angiofibroma in selected cases.