Search tips
Search criteria 


Logo of skullbasesurgInstructions for AuthorsSubscribe to Skull BaseAbout Skull BaseEditorial BoardThieme Medical PublishingSkull Base An Interdisciplinary Approach ...
Skull base surgery. 1995 October; 5(4): 219–226.
PMCID: PMC1656523

Microsurgery in Juvenile Nasopharyngeal Angiofibroma

A Lateronasal Approach with Nasomaxillary Pedicled Flap


Thirty-four consecutive juvenile nasopharyngeal angiofibromas, mainly stage II or III, were removed using a transnasomaxillary approach with good tumor control and without complications or sequelae. A pedicled nasomaxillary osteomucocutaneous flap is lifted through a lateronasal skin incision, and reflected laterally to open the nasal fossa and the maxillary sinus. This approach is an improvement on the conventional approach of lateral rhinotomy, which entails nasomaxillary skeletal loss. The approach ensures early and direct exposure of the root of the tumor and its vascular peduncle and also allows removal of tumors with intracranial extradural extensions.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.7M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Maurice M, Milad M. Pathogenesis of juvenile nasopharyngeal fibroma. (A new concept). J Laryngol Otol. 1981 Nov;95(11):1121–1126. [PubMed]
  • Osborn DA, Sokolovski A. Juvenile nasopharyngeal angiofibroma in a female. Report of a case. Arch Otolaryngol. 1965 Dec;82(6):629–632. [PubMed]
  • SCHIFF M. Juvenile nasopharyngeal angiofibroma. a theory of pathogenesis. Laryngoscope. 1959 Aug;69:981–1016. [PubMed]
  • HARMA RA. Nasopharyngeal angiofibroma; a clinical and histopathological study. Acta Otolaryngol Suppl. 1959;146:1–74. [PubMed]
  • Lee DA, Rao BR, Meyer JS, Prioleau PG, Bauer WC. Hormonal receptor determination in juvenile nasopharyngeal angiofibromas. Cancer. 1980 Aug 1;46(3):547–551. [PubMed]
  • Schiff M, Gonzalez AM, Ong M, Baird A. Juvenile nasopharyngeal angiofibroma contain an angiogenic growth factor: basic FGF. Laryngoscope. 1992 Aug;102(8):940–945. [PubMed]
  • Girgis IH, Fahmy SA. Nasopharyngeal fibroma: its histo-pathological nature. J Laryngol Otol. 1973 Nov;87(11):1107–1123. [PubMed]
  • Antonelli AR, Cappiello J, Di Lorenzo D, Donajo CA, Nicolai P, Orlandini A. Diagnosis, staging, and treatment of juvenile nasopharyngeal angiofibroma (JNA). Laryngoscope. 1987 Nov;97(11):1319–1325. [PubMed]
  • Brentani MM, Butugan O, Oshima CT, Torloni H, Paiva LJ. Multiple steroid receptors in nasopharyngeal angiofibromas. Laryngoscope. 1989 Apr;99(4):398–401. [PubMed]
  • Farag MM, Ghanimah SE, Ragaie A, Saleem TH. Hormonal receptors in juvenile nasopharyngeal angiofibroma. Laryngoscope. 1987 Feb;97(2):208–211. [PubMed]
  • Schuller DE, Abou-Issa H, Parrish R. Estrogen and progesterone receptors in head and neck cancer. Arch Otolaryngol. 1984 Nov;110(11):725–727. [PubMed]
  • Dohar JE, Duvall AJ., 3rd Spontaneous regression of juvenile nasopharyngeal angiofibroma. Ann Otol Rhinol Laryngol. 1992 Jun;101(6):469–471. [PubMed]
  • Harrison DF. The natural history, pathogenesis, and treatment of juvenile angiofibroma. Personal experience with 44 patients. Arch Otolaryngol Head Neck Surg. 1987 Sep;113(9):936–942. [PubMed]
  • Jacobsson M, Petruson B, Ruth M, Svendsen P. Involution of juvenile nasopharyngeal angiofibroma with intracranial extension. A case report with computed tomographic assessment. Arch Otolaryngol Head Neck Surg. 1989 Feb;115(2):238–239. [PubMed]
  • Weprin LS, Siemers PT. Spontaneous regression of juvenile nasopharyngeal angiofibroma. Arch Otolaryngol Head Neck Surg. 1991 Jul;117(7):796–799. [PubMed]
  • FURSTENBERG AC, BOLES R. NASOPHARYNGEAL ANGIOFIBROMA. Trans Am Acad Ophthalmol Otolaryngol. 1963 Jul-Aug;67:518–523. [PubMed]
  • Mertz JS, Pearson BW, Kern EB. Lateral rhinotomy. Indications, technique, and review of 226 patients. Arch Otolaryngol. 1983 Apr;109(4):235–239. [PubMed]
  • Neel HB, 3rd, Whicker JH, Devine KD, Weiland LH. Juvenile angiofibroma. Review of 120 cases. Am J Surg. 1973 Oct;126(4):547–556. [PubMed]
  • Waldman SR, Levine HL, Astor F, Wood BG, Weinstein M, Tucker HM. Surgical experience with nasopharyngeal angiofibroma. Arch Otolaryngol. 1981 Nov;107(11):677–682. [PubMed]
  • Witt TR, Shah JP, Sternberg SS. Juvenile nasopharyngeal angiofibroma. A 30 year clinical review. Am J Surg. 1983 Oct;146(4):521–525. [PubMed]
  • Conley J, Price JC. Sublabial approach to the nasal and nasopharyngeal cavities. Am J Surg. 1979 Oct;138(4):615–618. [PubMed]
  • FIGI FA, DAVIS RE. The management of nasopharyngeal fibromas. Laryngoscope. 1950 Aug;60(8):794–814. [PubMed]
  • TAPIA ACUNA R. The nasopharyngeal fibroma and its treatment. AMA Arch Otolaryngol. 1956 Dec;64(6):451–455. [PubMed]
  • WILSON CP. Observations on the surgery of the nasopharynx. Ann Otol Rhinol Laryngol. 1957 Mar;66(1):5–40. [PubMed]
  • Bocca E. Transpharyngeal approach to nasopharyngeal fibroma. Ann Otol Rhinol Laryngol. 1971 Apr;80(2):171–176. [PubMed]
  • KREMEN AJ. Surgical management of angiofibroma of the nasopharynx. Ann Surg. 1953 Oct;138(4):672–677. [PubMed]
  • Samy LL, Girgis IH. Transzygomatic approach for nasopharyngeal fibromata with extrapharyngeal extension. J Laryngol Otol. 1965 Sep;79(9):782–795. [PubMed]
  • Fisch U. The infratemporal fossa approach for nasopharyngeal tumors. Laryngoscope. 1983 Jan;93(1):36–44. [PubMed]
  • Biller HF, Sessions DG, Ogura JH. Angiofibroma: a treatment approach. Laryngoscope. 1974 May;84(5):695–706. [PubMed]
  • Standefer J, Holt GR, Brown WE, Jr, Gates GA. Combined intracranial and extracranial excision of nasopharyngeal angiofibroma. Laryngoscope. 1983 Jun;93(6):772–779. [PubMed]
  • Krekorian EA, Kempe LG. The combined otolaryngology-neurosurgery approach to extensive benign tumors. Laryngoscope. 1969 Dec;79(12):2086–2103. [PubMed]
  • Pech A, Cannoni M, Gitenet P, Abdul S. Le traitement chirurgical du fibrome naso-pharyngien. J Fr Otorhinolaryngol Audiophonol Chir Maxillofac. 1977 Jan;26(1):61–74. [PubMed]
  • Mann W, Gilsbach J. Operative Zugangswege bei Tumoren des Nasenrachens und des retromaxillären Raumes im Kindesalter. Laryngol Rhinol Otol (Stuttg) 1984 Apr;63(4):189–192. [PubMed]
  • HEERMANN H. Uber endonasale Chirurgie unter Verwendung des binocularen Mikroskopes. Arch Ohren Nasen Kehlkopfheilkd. 1958;171(2):295–297. [PubMed]
  • Djindjian R, Cophignon J, Théron J, Merland JJ, Houdart R. Embolization by superselective arteriography from the femoral route in neuroradiology. Review of 60 cases. 1. Technique, indications, complications. Neuroradiology. 1973 Sep;6(1):20–26. [PubMed]
  • Roberson GH, Biller H, Sessions DG, Ogura JH. Presurgical internal maxillary artery embolization in juvenile angiofibroma. Laryngoscope. 1972 Aug;82(8):1524–1532. [PubMed]
  • 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. [PubMed]
  • Lund VJ, Lloyd GA, Howard DJ. Juvenile angiofibroma--imaging techniques in diagnosis. Rhinology. 1989 Sep;27(3):179–185. [PubMed]
  • Boles R, Dedo H. Nasopharyngeal angiofibroma. Laryngoscope. 1976 Mar;86(3):364–372. [PubMed]
  • Bremer JW, Neel HB, 3rd, DeSanto LW, Jones GC. Angiofibroma: treatment trends in 150 patients during 40 years. Laryngoscope. 1986 Dec;96(12):1321–1329. [PubMed]
  • Economou TS, Abemayor E, Ward PH. Juvenile nasopharyngeal angiofibroma: an update of the UCLA experience, 1960-1985. Laryngoscope. 1988 Feb;98(2):170–175. [PubMed]
  • Gullane PJ, Davidson J, O'Dwyer T, Forte V. Juvenile angiofibroma: a review of the literature and a case series report. Laryngoscope. 1992 Aug;102(8):928–933. [PubMed]
  • Spector JG. Management of juvenile angiofibromata. Laryngoscope. 1988 Sep;98(9):1016–1026. [PubMed]
  • Maharaj D, Fernandes CM. Surgical experience with juvenile nasopharyngeal angiofibroma. Ann Otol Rhinol Laryngol. 1989 Apr;98(4 Pt 1):269–272. [PubMed]
  • SARDANA DS. NASOPHARYNGEAL FIBROMA: EXTENSION INTO CHEEK. Arch Otolaryngol. 1965 Jun;81:584–588. [PubMed]
  • 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. [PubMed]
  • Jafek BW, Krekorian EA, Kirsch WM, Wood RP. Juvenile nasopharyngeal angiofibroma: management of intracranial extension. Head Neck Surg. 1979 Nov-Dec;2(2):119–128. [PubMed]
  • Ward PH, Thompson R, Calcaterra T, Kadin MR. Juvenile angiofibroma: a more rational therapeutic approach based upon clinical and experimental evidence. Laryngoscope. 1974 Dec;84(12):2181–2194. [PubMed]

Articles from Skull Base Surgery are provided here courtesy of Thieme Medical Publishers