Nasal juvenile angiofibroma: Current perspectives with emphasis on management

Abstract

Juvenile angiofibroma is an uncommon, benign, locally aggressive vascular tumor. It is found almost exclusively in young men. Common presenting symptoms include nasal obstruction and epistaxis. More advanced tumors may present with facial swelling and visual or neurological disturbances. The evaluation of patients with juvenile angiofibroma relies on diagnostic imaging. Preoperative biopsy is not recommended. The mainstay of treatment is resection combined with preoperative embolization. Endoscopic surgery is the approach of choice in early stages, whereas, in advanced stages, open or endoscopic approaches are feasible in expert hands. Postoperative radiotherapy (RT) or stereotactic radiosurgery seem valuable in long-term control of juvenile angiofibroma, particularly those that extend to anatomically critical areas unsuitable for complete resection. Chemotherapy and hormone therapy are ineffective. The purpose of the present review was to update current aspects of knowledge related to this rare and challenging disease. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1033-1045, 2017.

Management of persistent juvenile angiofibroma after endoscopic resection: Analysis of a single institution series of 74 patients

“…Current indications for follow‐up in patients treated for JA focus on early identification of persistent lesions in order to perform timely revision treatment, if dictated by the critical anatomic site of the lesion and/or the young age of the patient . On the other hand, no clear consensus exists about the duration of follow‐up .…”

“…This possibility has been first demonstrated by Kania et al by using CT with contrast medium, and confirmed in our most recent cases by performing early postoperative MRI with gadolinium enhancement. In patients with pJA on early postoperative imaging, the option to immediately perform revision surgery, which spares the patient more complex treatments in the future, should be considered . Moreover, it can be hypothesized that postpubertal patients with negative postoperative imaging will have a very low chance of developing a clinically relevant recurrence.…”

“…Treatment of all pJA with radiotherapy, without considering the variability of lesion growth, may result in unnecessary irradiation. In this scenario, a “wait and see” policy is advisable …”

Juvenile nasopharyngeal angiofibroma: A retrospective study of 27 cases in the ENT department of IPO‐PORTO

“…3 It is thought that JNA originates from the posterosuperior margin of the sphenopalatine foramen. [1][2][3][4][5][6] Due to their anatomical location near the skull base and their tendency towards local invasion, these tumours tend to originate extensive tissue destruction, bone remodelling 6 and frequent recurrence. This growth pattern and spreading to local structures is unpredictable and at the time of diagnosis, most tumours are locally advanced.…”

Sirolimus for the treatment of juvenile nasopharyngeal angiofibroma

“…2‐ More recently, transnasal endoscopic or endoscopic assisted approaches have become the standard of care . Preoperative selective embolization of feeding arteries has been used to decrease risk of intraoperative hemorrhage . Adjuvant radiotherapy has fallen out of favor due to the risk of pituitary damage and secondary malignancies but has been used in patients with no other options.…”