Endoscopic Endonasal and Transmaxillary Resection of a Nasopharyngeal Angiofibroma.

Juvenile nasopharyngeal angiofibromas (JNAs) are highly vascularized benign lesions that mainly arise in adolescent male patients. Current treatment options include observation, radiotherapy, or surgical resection. Surgical resection is the treatment of choice as it achieves immediate and complete results, thereby minimizing the risk of recurrence. Here we have reported on a transnasal-transmaxillary endoscopic approach for resection of a JNA in a 16-year-old male patient. The patient presented with 1 year of progressive nasal obstruction and intermittent episodes of right-sided epistaxis. Because of the highly vascular nature of the tumor, embolization of the internal maxillary artery and branches was performed 1 day prior to surgery. Under endoscopic visualization, the right nasal cavity was entered and the tumor was debulked. An anterior maxillary antrotomy via a sublabial approach was completed for further access. A maxillary antrostomy, ethmoidectomy, and sphenoidotomy was performed (Video 1). The pterygopalatine fossa was entered, dissected, and the tumor was circumferentially freed from the masticator space laterally, the orbit and skull base superiorly, and the basisphenoid posteriorly. The pterygoid plates and basisphenoid were drilled down to ablate residual tumor. The patient tolerated the procedure well and postoperative magnetic resonance imaging confirmed gross total resection. The sinonasal cavity was widely patent and no tumor recurrence was noted 5 months postoperatively. JNAs can be challenging to treat as they can invade extensively into local structures. A careful consideration of treatment options and approaches are necessary when faced with these lesions.