[Angifibroma juvenile--evolution of surgical management]. / Ewolucja chirurgicznych metod leczenia wlókniaka mlodzienczego.

INTRODUCTION: Juvenile Angiofibroma has been challenged generations of surgeons. The problem is, not only in specific clinical features of the tumour, but also in difficult surgical approach to anatomical area in which it is located. THE AIM OF THE STUDY: was to analyze development of surgical techniques in treatment of juvenile angiofibroma and potential conditions which influence on therapy results. MATERIAL AND METHOD: The retrospective study that analyzes 47 juvenile angiofibroma cases, which were treated in the Otorhinolaryngology Department of Warsaw Medical University in years 1980­2010. RESULTS: The five surgical approaches were used in the group of patients, filled in this study. The use of midfacial degloving has become increasingly popular, replacing lateral rhinotomy and transpalatal approach, which were commonly used in early nineties of the last century. The infratemporal approach was used in one case of disease with parapharyngeal and infratemporal extension. One of the recent patients was treated, first time in history of the Department, using endoscopic approach. The routine protocol of treatment includes preoperative CT and MRI and angiography with embolization of the main tumour vessels. The gradual, but consequent improvement in therapy results is revealed as reduction of recurrence from 35% to 20%. CONCLUSIONS: In therapy of juvenile angiofibroma become popular surgical techniques, which are not connected with visible scars and which reduce tissue trauma in operated area. Besides mastering surgical skills, the independent condition, which improves therapy results, is using modern diagnostic and therapeutic procedures. They contribute to better assessment of tumour location and extension, and reduction of intraoperative blood loss.