IJSRP, Volume 3, Issue 6, June 2013 Edition [ISSN 2250-3153]
Purushothaman P K, Ramakrishnan R, Kiruthiga Devi M
Juvenile nasopharyngeal angiofibroma is a rare benign neoplasm that occurs in the nasopharynx particularly seen in young adolescent males. Surgery is the primary treatment of choice. Surgical approaches are either a standard open method or with the advent of endoscopes, recently it is endoscopic endonasal approach. With either of the approaches, it poses a great surgical challenge for the surgeons because of the vascular nature of the tumor and hence its risk for torrential bleed. Preoperative endovascular embolization has significantly reduced the risk of intraoperative bleeding and aids in tumor removal. However, embolization facilities are not available at all centres and embolization per se itself carries risk as high as 20 % leading to central artery occlusion, oroantral fistula due to tissue necrosis, occlusion of the middle cerebral artery followed by stroke and occlusion of ophthalmic artery. We present this article to share our experience of resection of juvenile nasopharyngeal angiofibroma using endoscopic endonasal approach without prior preoperative embolization and the importance of working around the periphery of the tumor with ligation of pedicle which helps in significant reduction of intraoperative bleed.