[Analysis of surgical treatment of nasopharyngeal angiofibroma].

OBJECTIVE: To study the individual surgical treatment of nasopharyngeal angiofibroma. METHODS: Between Feb. 1989 and Oct. 2004, different kinds of surgical approaches in 51 patients with angiofibromas were retrospectively analysed. Using Fisch stage: thirty three cases were in stage I and II, 22 cases via palatal approach, 11 cases via endoscopic surgery;18 cases were in stage IIN and IV, 9 cases via lateral rhinotomy approach, 4 cases via midfacial degloving approach + Lefort I approach or modified maxillotomy, 5 cases via craniofacial approach. Twenty three cases accepted the embolization of the artery which feed the tumor, 7 cases in stage IV, 8 cases in stage IlI, 5 cases in stage II, 3 cases in stage I. RESULTS: The average of blood loss was 1010 ml in operation but it became 200 - 870 ml (the average of blood loss was 485 ml) when had a selective preoperative embolization. The blood loss of none selective preoperative embolization was 500 - 3500 ml (the average of blood loss was 1600 ml), t = 7. 48, P < 0.05, the average of blood loss of selective preoperative embolization is less than the average of blood loss of none selective preoperative embolization. After 9 to 48 months of operation (the average time was 26.4 months), 8 cases recurred one time and 2 cases recurred two times. CONCLUSIONS: The preoperative embolization could reduce the amount of bleeding during operation. In patients who are in stage I and II, searching endoscopic surgery could avoid the effect on craniofacial development which traditional surgical procedure did. For patient who are in stage III and IV, midfacial degloving approach and Lefort I approach or modified maxillotomy are not only good for exclusive resection of the tumor but also have less effect on articulation and beautiful cosmetic outlook.