Juvenile nasopharyngeal angiofibroma. A 30 year clinical review.

Overview

Thirty-one patients with juvenile nasopharyngeal angiofibroma treated at Memorial Sloan-Kettering Cancer Center from 1949 to 1979 were reviewed. Eighteen of the patients were previously untreated and in the other 13, previous treatment elsewhere had failed. Median follow-up was 54 months. All the patients were male adolescents whose presentations were characterized by epistaxis (73 percent) and nasal obstruction (60 percent). The tumors invariably arose within the nasal cavity or nasopharynx and involved neighboring structures in 58 percent of the patients. Treatment included surgery (30 patients), radiotherapy (13 patients), the administration of androgens (11 patients), sclerotherapy (2 patients), and cryotherapy (1 patient). Of the 18 primary patients, 14 were managed surgically with irradication of disease in 12 (86 percent). Of the four primary patients initially treated nonsurgically, disease recurred in three, all of whom were rendered free of disease by surgical excision. Of the 13 secondary patients, 8 were free of disease after surgery only, and 2 were free of disease after multimodal therapy with surgery being the last treatment employed. There were no deaths. Maxillary radionecrosis (one patient) and facial cellulitis (three patients) constituted the only significant morbidity. This study has demonstrated the clinical characteristics of juvenile nasopharyngeal angiofibroma and supports the primary role of surgical excision in its management.