Nasopharyngeal Angiofibroma - Evaluation and Management

Objective: To present our experience with 24 patients of Nasopharyngeal Angiofibroma who underwent surgical resection. Design: A descriptive study Setting: Department of ENT, Postgraduate Medical Institute, Lady Reading Hospital Peshawar. Patients and methods: This study included 24 consecutive cases of nasopharyngeal angiofibroma over a period of 5 years. All patients were admitted. Detailed History, clinical examination and relevant investigations were done. Contrast-enhanced CT scan was done in all cases and in selected patients MRI was also done. All the patients underwent surgical excision using various surgical approaches. Patients were regularly followed for any recurrence. Results: All the patients were male and the average age at diagnosis was 16.5 (range 10-24) years. Nasal obstruction and recurrent epistaxis were the presenting complaints in all cases. Other signs and symptoms included hearing loss, headache, cheek swelling, proptosis, obvious nasal deformity and nasal mass. Contrast-enhanced CT delineated well the tumour and its extensions. All the patients underwent surgical resection of the tumour. In 12 patients tumour resection was done by lateral rhinotomy, in 6 sub labial midfacial degloving approach, in 3 transnasal transmaxillary approach via Weber-Fergusson incision and in 3 transpalatine approach was used. None of the tumours were embolized prior to surgery. The overall recurrence rate was 29.17%. Conclusion: Nasopharyngeal angiofibroma is a rare, benign and extremely vascular neoplasm of the nasopharynx which occurs in adolescent males. Preoperative evaluation of tumour extent is best done by CT scan and MRI. Pre operative embolization is not obligatory. Surgical excision is the treatment of choice. Most of the tumours are excisable by lateral rhinotomy and midfacial degloving approach, with minimal chance of recurrence.