Experience in the surgical management of juvenile angiofibroma from 2016 to 2022 at a national pediatric reference center in Peru
DOI:
https://doi.org/10.59594/iicqp.2025.v3n2.143Keywords:
Angiofibroma, Surgical Procedures, Operative, Endoscopic Surgical Procedures, Osteotomy, Le FortAbstract
Introduction: Juvenile angiofibroma is a benign neoplasm with a prominent vascular component, most frequently presenting with nasal obstruction and epistaxis. Studies on this pathology are scarce, with most consisting of case reports or small case series describing a single surgical approach.
Objectives: To describe the clinical characteristics, surgical management, and complications of juvenile angiofibroma in patients treated at the Instituto Nacional de Salud del Niño San Borja (Lima, Peru), from 2016 to 2022.
Materials and Methods: Observational, descriptive study including patients with a histopathological diagnosis of juvenile angiofibroma who underwent surgical treatment during the study period. Sociodemographic, clinical, and surgical variables were collected. Tumor staging was performed using the Andrews-Fisch classification.
Results: Seventy-four male patients with a mean age of 14 ± 1 years (range: 8–17 years) underwent surgical treatment. Sixty-six percent received a Le Fort I osteotomy, and 34 % underwent endoscopic surgery. Nasal obstruction was the predominant symptom in both groups, followed by epistaxis. Among tumors treated with Le Fort I osteotomy, 53 % were classified as stage IIIa, whereas 52 % of those treated endoscopically were classified as stage I. Two patients (4%) died due to surgical complications: one from cavernous sinus rupture during surgery, and the other from persistent status epilepticus on postoperative day four.
Conclusions: The surgical management of juvenile angiofibroma should be guided by the tumor's extension. Endoscopic surgery is recommended for stages I and II, while open surgery is suggested for stages III and IV. Maintaining a high level of clinical suspicion in cases of epistaxis is crucial for providing timely management, preferably through endoscopic surgery in the early stages.
Downloads
References
Iovanescu G, Ruja S, Cotulbea S. Juvenile nasopharyngeal angiofibroma: Timisoara ENT Department's experience. Int J Pediatr Otorhinolaryngol. 2013;77(7):1186-9. doi: 10.1016/j.ijporl.2013.04.035
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;43(8):1501-4. doi: 10.1016/j.jcms.2015.06.032
Shah SR, Keshri A, Patadia S, Sahu RN, Srivastava AK, Behari S. Stage III nasopharyngeal angiofibroma: Improving results with endoscopic-assisted midfacial degloving and modification to the Fisch staging system. J Craniomaxillofac Surg. 2015;43(8):1678-83. doi: 10.1016/j.jcms.2015.07.025
Liu ZF, Wang DH, Sun XC, Wang JJ, Hu L, Li H, et al. The site of origin and expansive routes of juvenile nasopharyngeal angiofibroma (JNA). Int J Pediatr Otorhinolaryngol. 2011;75(9):1088-92. doi: 10.1016/j.ijporl.2011.05.020
Yi Z, Fang Z, Lin G, Lin C, Xiao W, Li Z, et al. Nasopharyngeal angiofibroma: a concise classification system and appropriate treatment options. Am J Otolaryngol. 2013;34(2):133-41. doi: 10.1016/j.amjoto.2012.10.004
Hyun DW, Ryu JH, Kim YS, Kim KB, Kim WS, Kim CH, et al. Treatment outcomes of juvenile nasopharyngeal angiofibroma according to surgical approach. Int J Pediatr Otorhinolaryngol. 2011;75(1):69-73. doi: 10.1016/j.ijporl.2010.10.010
Singh R, Hazarika P, Nayak DR, Balakrishnan R, Pillai S, Hazarika M. Role of Le Fort type I osteotomy approach in juvenile nasopharyngeal angiofibroma. Int J Oral Maxillofac Surg. 2011;40(11):1271-4. doi: 10.1016/j.ijom.2011.05.016
Oliveira JA, Tavares MG, Aguiar CV, Azevedo JF, Sousa JR, Almeida PC, et al. Comparison between endoscopic and open surgery in 37 patients with nasopharyngeal angiofibroma. Braz J Otorhinolaryngol. 2012;78(1):75-80. doi: 10.1590/s1808-86942012000100012
Kopeć T, Borucki Ł, Szyfter W. Fully endoscopic resection of juvenile nasopharyngeal angiofibroma - own experience and clinical outcomes. Int J Pediatr Otorhinolaryngol. 2014;78(7):1015-8. doi: 10.1016/j.ijporl.2014.03.027
El Sharkawy AA, Elmorsy SM. Transnasal endoscopic management of recurrent juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol. 2011;75(5):620-3. doi: 10.1016/j.ijporl.2011.01.033
Andrews JC, Fisch U, Valavanis A, Aeppli U, Makek MS. The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach. Laryngoscope. 1989;99(4):429-37. doi: 10.1288/00005537-198904000-00013
Godoy MD, Bezerra TF, Pinna Fde R, Voegels RL. Complications in the endoscopic and endoscopic-assisted treatment of juvenile nasopharyngeal angiofibroma with intracranial extension. Braz J Otorhinolaryngol. 2014;80(2):120-5. doi: 10.5935/1808-8694.20140026
Oré JF, Saavedra J, Pasache L, Iwaki R, Avello F, Cárdenas J. Manejo quirúrgico del nasoangiofibroma juvenil. An Fac Med [Internet]. 2007 [citado el 13 de marzo de 2025];68(3):254-63. Disponible: https://revistasinvestigacion.unmsm.edu.pe/index.php/anales/article/view/1212
Oré Acevedo JF, La Torre Caballero LM, Urteaga Quiroga RJ. Tratamiento quirúrgico del angiofibroma nasofaríngeo juvenil en pacientes pediátricos. Acta Otorrinolaringol Esp. 2019;70(5):279-85. doi: 10.1016/j.otorri.2018.06.003
Dejo F. Manejo quirúrgico del nasoangiofibroma juvenil en el Hospital Nacional Guillermo Almenara Irigoyen, ESSALUD. Junio 1997 – mayo 2000. [Tesis para segunda especialidad en Internet]. Lima: Universidad Nacional Mayor de San Marcos; 2006 [citado el 13 de marzo de 2025]. 33 p. Disponible en: https://hdl.handle.net/20.500.12672/15745
Cruz J. Manejo quirúrgico del angiofibroma nasofaríngeo juvenil en el Hospital Edgardo Rebagliati Martins de enero 2000 a diciembre 2008. [Tesis para segunda especialidad en Internet]. Lima: Universidad Nacional Mayor de San Marcos; 2009 [citado el 13 de marzo de 2025]. 56 p. Disponible en: https://hdl.handle.net/20.500.12672/2435
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;150(3):350-8. doi: 10.1177/0194599813516605
Boghani Z, Husain Q, Kanumuri VV, Khan MN, Sangvhi S, Liu JK, et al. Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic-assisted, and open resection in 1047 cases. Laryngoscope. 2013;123(4):859-69. doi: 10.1002/lary.23843
Langdon C, Herman P, Verillaud B, Carrau RL, Prevedello D, Nicolai P, et al. Expanded endoscopic endonasal surgery for advanced stage juvenile angiofibromas: a retrospective multi-center study. Rhinology. 2016;54(3):239-46. doi: 10.4193/Rhino15.104
Fyrmpas G, Konstantinidis I, Constantinidis J. Endoscopic treatment of juvenile nasopharyngeal angiofibromas: our experience and review of the literature. Eur Arch Otorhinolaryngol. 2012;269(2):523-9. doi: 10.1007/s00405-011-1708-6
Cohen-Cohen S, Scheitler KM, Choby G, Janus J, Moore EJ, Kasperbauer JL, et al. Contemporary Surgical Management of Juvenile Nasopharyngeal Angiofibroma. J Neurol Surg B Skull Base. 2021;83(Suppl 2):e266-73. doi: 10.1055/s-0041-1725031
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;147(5):958-63. doi: 10.1177/0194599812454394
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Investigación e Innovación Clínica y Quirúrgica Pediátrica
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
This website is published under the 
