Strategies to Minimize Recurrence in Locally Advanced Juvenile Angiofibroma: Expert Series and Video Demonstration

Objectives: Discuss and present video demonstrations of techniques to aid in minimizing recurrence of locally advanced juvenile nasopharyngeal angiofibromas (JNAs).

Methods: Case series and video demonstration.

Results: We report an expert series and video demonstration of resection of 3 locally advanced primary JNAs treated at a single institution. Average age of these patients was 19-years and all patients were male. All patients were Radowski Stage 2C and underwent preoperative embolization. There were no recurrences on exam or MRI at mean follow-up of 26 months. On review (and presented in video footage demonstration), techniques to minimize recurrence/persistence of disease include the following: (1) resection of involved base of the pterygoids and pterygoid plates, (2) resection of the basisphenoid including disease involving the vidian foramen and foramen rotundum, (3) clearing disease extending into the infraorbital fissure, (4) clearing disease from foramen ovale, and (5) addressing disease extending into the infratemporal fossa. Surgical techniques and video footage are presented.

Conclusion: Areas high-risk for recurrence in locally advanced JNAs include the pterygoid plates, basisphenoid (vidian canal and foramen rotundum), infraorbital fissure, foramen ovale, and infratemporal fossa. We discuss and present video demonstrations of techniques to help minimize recurrence.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022