International Journal of Head and Neck Surgery

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VOLUME 9 , ISSUE 1 ( January-March, 2018 ) > List of Articles


Current Management and Controversies of Juvenile Angiofibromas

Colin R Butler, Daniel W Scholfield, Gitta Madani, Ann Sandison, Peter M Clarke

Keywords : Angiofibroma, Juvenile nasopharyngeal angiofibroma

Citation Information : Butler CR, Scholfield DW, Madani G, Sandison A, Clarke PM. Current Management and Controversies of Juvenile Angiofibromas. Int J Head Neck Surg 2018; 9 (1):32-37.

DOI: 10.5005/jp-journals-10001-1334

License: CC BY-NC 4.0

Published Online: 01-08-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Juvenile angiofibromas are benign, highly vascular lesions that are found in young male patients with an incidence of approximately 1: 150,000. They are thought to arise from a residual vascular plexusin the pterygopalatine fossa at the aperture of the pterygoid canal, as a remnant of the involution of the first branchial arch artery. Juvenile angiofibromas remain challenging to treat. Early staged disease can be adequately treated by endoscopic approaches and with increasing experience, even higher staged disease has been shown to be resectable

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  1. Lund VJ, Stammberger H, Nicolai P, Castelnuovo P, Beal T, Beham A, Bernal-Sprekelsen M, Braun H, Cappabianca P, Carrau R, et al.; European Rhinologic Society Advisory Board on Endoscopic Techniques in the Management of Nose, Paranasal Sinus and Skull Base Tumours. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol (Suppl) 2010 Jun;22:1-143.
  2. Lloyd G, Howard D, Phelps P, Cheesman A. Juvenile angiofibroma: the lessons of 20 years of modern imaging. J Laryngol Otol 1999 Feb;113(2):127-134.
  3. Schick B, Urbschat S. New aspects of pathogenesis of juvenile angiofibroma. Hosp Med 2004 May;65(5):269-273.
  4. Glad H, Vai ner B, Buchwald C, Petersen BL, Theilgaard SA, Bonvin P, Lajer C, Jakobsen J. Juvenile nasopharyngeal angiofibromas in Denmark 1981-2003: diagnosis, incidence, and treatment. Acta Otolaryngol 2007 Mar;127(3):292-299.
  5. Hwang HC, Mills SE, Patterson K, Gown AM. Expression of androgen receptors in nasopharyngeal angiofibroma: an immunohistochemical study of 24 cases. Mod Pathol 1998 Nov;11(11):1122-1126.
  6. Gates GA, Rice DH, Koopmann CF Jr, Schuller DE. Flutamide induced regression of angiofibroma. Laryngoscope 1992 Jun;102(6):641-644.
  7. Leong SC. A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement. Laryngoscope 2013 May;123(5): 1125-1131.
  8. Stelow EB, Wenig BM. Update from the 4th edition of the World Health Organization classification of head and neck tumours: nasopharynx. Head Neck Pathol 2017 Mar;11(1):16-22.
  9. Lloyd G, Howard D, Lund VJ, Savy L. Imaging for juvenile angiofibroma. J Laryngol Otol 2000 Sep;114(9):727-730.
  10. Radkowski D, McGill T, Healy GB, Ohlms L, Jones DT. Angiofibroma: changes in staging and treatment. Arch Otolaryngol Head Neck Surg 1996 Feb;122(2):122-129.
  11. Fisch U. The infratemporal fossa approach for nasopharyngeal tumors. Laryngoscope 1983 Jan;93(1):36-44.
  12. Andrews JC, Fisch U, Valavanis A, Aeppli U, Makek MS. The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach. Laryngoscope 1989 Apr;99(4):429-437.
  13. Chandler JR, Goulding R, Moskowitz L, Quencer RM. Nasopharyngeal angiofibromas: staging and management. Ann Otol Rhinol Laryngol 1984 Jul-Aug;93(4 Pt 1):322-329.
  14. Snyderman CH, Pant H, Carrau RL, Gadner P. A new endoscopic staging system for angiofibromas. Arch Otolaryngol Head Neck Surg 2010 Jun;136(6):588-594.
  15. Cloutier T, Pons Y, Blancal JP, Sauvaget E, Kania R, Bresson D, Herman P. Juvenile nasopharyngeal angiofibroma: does the external approach still make sense? Otolaryngol Head Neck Surg 2012 Nov;147(5):958-963.
  16. Kamel RH. Transnasal endoscopic surgery in juvenile nasopharyngeal angiofibroma. J Laryngol Otol 1996 Oct;110(10):962-968.
  17. Langdon C, Herman P, Verillaud B, Carrau RL, Prevedello D, Nicolai P, Schreiber A, Padoan G, Castelnuovo P, Bernal- Sprekelsen M. Expanded endoscopic endonasal surgery for advanced stage juvenile angiofibromas: a retrospective multicentre study. Rhinology 2016 Sep;54(3):239-246.
  18. Khoueir N, Nicolas N, Rohayem Z, Haddad A, Abou Hamad W. Exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma: a systematic review of the literature. Otolaryngol Head Neck Surg 2014 Mar;150(3):350-358.
  19. Carrau RL, Snyderman CH, Kassam AB, Jungreis CA. Endoscopic and endoscopic-assisted surgery for juvenile angiofibroma. Laryngoscope 2001 Mar;111(3):483-487.
  20. López F, Triantafyllou A, Snyderman CH, Hunt JL, Suárez C, Lund VJ, Strojan P, Saba NF, Nixon IJ, Devaney KO, et al. Nasal juvenile angiofibroma: current perspectives with emphasis on management. Head Neck 2017 May;39(5):1033-1045.
  21. Marshall AH, Bradley PJ. Management dilemmas in the treatment and follow-up of advanced juvenile nasopharyngeal angiofibroma. ORL J Otorhinolaryngol Relat Spec 2006 May;68(5):273-278.
  22. Bales C, Kotapka M, Loevner LA, Al-Rawi M, Weinstein G, Hurst R, Weber RS. Craniofacial resection of advanced juvenile nasopharyngeal angiofibroma. Arch Otolaryngol Head Neck Surg 2002 Sep;128(9):1071-1078.
  23. de Mello-Filho FV, Araujo FC, Marques Netto PB, Pereira-Filho FJ, de Toledo-Filho RC, Faria AC. Resection of a juvenile nasoangiofibroma by Le Fort I osteotomy: experience with 40 cases. J Craniomaxillofac Surg 2015 Oct;43(8): 1501-1504.
  24. Boghani Z, Husain Q, Kanumuri VV, Khan MN, Sangvhi S, Liu JK, Eloy JA. Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopicassisted, and open resection in 1047 cases. Laryngoscope 2013 Apr;123(4):859-869.
  25. Ballah D, Rabinowitz D, Vossough A, Rickert S, Dunham B, Kazahaya K, Cahill AM. Preoperative angiography and external carotid artery embolization of juvenile nasopharyngeal angiofibromas in a tertiary referral paediatric centre. Clin Radiol 2013 Nov;68(11):1097-1106.
  26. Gao M, Gemmete JJ, Chaudhary N, Pandey AS, Sullivan SE, McKean EL, Marentette LJ. A comparison of particulate and onyx embolization in preoperative devascularization of juvenile nasopharyngeal angiofibromas. Neuroradiology 2013 Sep;55(9):1089-1096.
  27. Lutz J, Holtmannspötter M, Flatz W, Meier-Bender A, Berghaus A, Brückmann H, Zengel P. Preoperative embolization to improve the surgical management and outcome of juvenile nasopharyngeal angiofibroma (JNA) in a single center: 10-year experience. Clin Neuroradiol 2016 Dec;26(4): 405-413.
  28. Ramezani A, Haghighatkhah H, Moghdasi H, Taheri MS, Parsafar H. A case of central retinal artery occlusion following embolization procedure for juvenile nasopharyngeal angiofibroma. Indian J Ophthalmol 2010 Sep-Oct;58(5): 419-421.
  29. Trivedi M, Desai RJ, Potdar NA, Shinde CA, Ukirde V, Bhuta M, Nair AG. Vision loss due to central retinal artery occlusion following embolization in a case of a giant juvenile nasopharyngeal angiofibroma. J Craniofac Surg 2015 Jul;26(5):e451-e453.
  30. Mann WJ, Jecker P, Amedee RG. Juvenile angiofibromas: changing surgical concept over the last 20 years. Laryngoscope 2004 Feb;114(2):291-293.
  31. Rowan NR, Zwagerman NT, Heft-Neal ME, Gardner PA, Snyderman CH. Juvenile nasal angiofibromas: a comparison of modern staging systems in an endoscopic era. J Neurol Surg B Skull Base 2017 Feb;78(1):63-67.
  32. Amdur RJ, Yeung AR, Fitzgerald BM, Mancuso AA, Werning JW, Mendenhall WM. Radiotherapy for juvenile nasopharyngeal angiofibroma. Pract Radiat Oncol 2011 Oct-Dec;1(4):271-278.
  33. Lee JT, Chen P, Safa A, Juillard G, Calcaterra TC. The role of radiation in the treatment of advanced juvenile angiofibroma. Laryngoscope 2002 Jul;112(7 Pt 1):1213-1220.
  34. Chen KT, Bauer FW. Sarcomatous transformation of nasopharyngeal angiofibroma. Cancer 1982 Jan;49(2):369-371.
  35. Hodges JM, McDevitt AS, El-Sayed Ali AI, Sebelik ME. Juvenile nasopharyngeal angiofibroma: current treatment modalities and future considerations. Indian J Otolaryngol Head Neck Surg 2010 Sep;62(3):236-247.
  36. Tosun F, Onerci M, Durmaz A, Ugurel S. Spontaneous involution of nasopharyngeal angiofibroma. J Craniofac Surg 2008 Nov;19(6):1686-1689.
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