Navigating the nasopharyngeal maze: Balanced surgical approach for advanced juvenile angiofibromas

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) are fibrovascular tumors of the nasopharynx. These tumors are very vascular and non-encapsulated and predominantly affect young males aged 14–25 years. Clinically, JNA presents with unilateral nasal obstruction and recurrent epistaxis. Advanced instances may result in proptosis, cranial neuropathy, facial edema, and potentially fatal bleeding. The tumors exhibit local invasiveness which can extend intracranially. In this study, we reviewed two cases of extensive nasopharyngeal angiofibroma treated at our institute using the maxillary swing technique. The surgical approach was chosen based on tumor extent, blood supply, and the presence or absence of intracranial extension. Preoperatively, patients underwent tracheostomy and embolization. Both patients underwent successful surgical excision via the maxillary swing approach. We report the anticipated complications, their management, and the outcomes of these cases. Long-term follow-up revealed no recurrence, and both patients regained normal nasal function.