This document describes endoscopic surgery for juvenile angiofibroma in two case studies. Juvenile angiofibroma is a highly vascularized benign tumor that typically affects adolescent boys, presenting with nasal obstruction and epistaxis. It originates in the nasal cavity and can invade local structures such as the sinuses. Endoscopic surgery was performed on two boys, ages 12 and 14, who presented with nasal obstruction and occasional epistaxis. The endoscopic approach allowed for tumor removal with magnified views but is limited to smaller tumors. Post-surgical follow up with MRI was conducted for several years to monitor recurrence.

1. ENDOSCOPIC SURGERY FOR
JUVENILE ANGIOFIBROMA
two cases
Department of Otorhinolaryngology
and Head & Neck Surgery, Sestre milosrdnice
hospital, Zagreb
Baudoin T, Shejbal D, Grgić M, Drviš P, Stevanović S.

2. Juvenile angiofibroma:
• Highly vascularized benign tumor
• Vascular malformation
• Loc. invasive
• Children and adolescent boys
• Nasal obstruction and epistaxis
• Purpur polypoid NF mass
• Origin: NF or lateral wall of nasal cavity

3. Spread:
• Sfenopalatinal foramen
• NF i nasal cavityn
• Bone errosion. sphenoid,
ethmoid and maxilar
sinus, pterygomaxillary
fosa, infratemporalna
fossa, orbit
• intracranial invasion
(middle cranial fossa)

4. • I - tm limited to the NF
• II – invading the pterygopalatine fossa,
sphenoid, ethmoid and maxilary sinus with
bone destruction,
• III – invading infratemporalne fosse or
orbital region or extradural intracranial
invasion
• IV – intracranial intradural tumor

5. Dg:
• NMR
• Angiography
• Endoskopy
• NO biopsy!

6. Feeding vessels:
• A. sphenopalatina
(a. maxillaris)
• 50 % - additional
feeding
• 2/3 unilateral
• 1/3 contralateral
vascularisation

7. Th:
• Surgery
• Radiotherapy
• Chemotherapy
• Embolization - ( 24-72h)
• Authologous blood transfusion

8. Surgical options:
• Transpalatal
• Transfacial
• Transhyoid
• Infratemporal
• Endonasal

9. Endoscopic treatment:
• ETA, hypotension
• Uncinectomy, part. or total
resection of the middle
turbinate
• Ant. and post. ethmoidectomy
• Wide middle antrostomy
• Ressecion post. septum wall
with mass
• Mass removed transoraly or
transnasal
• Bipollar cautery, laser
• 3D - navigation

10. Endoscopic treatment (II):
• advantages:
magnified, multy angled view
it does not require any skin or mucosal
incision or osteotomy
• limitations:
availability of only one hand for surgical
maneuvers
usefull only for I and II type

11. Postsurgical follow up:
• NMR
first year - 4 month.
next 4 years – 6 month

12. • 12 and 14 year old boy wit angiofibroma of
right nasal cavity
• 4 months ago: nasal obstruction with
occasional epistaxis
• Diagnosis: X ray and anterior rhynoscopy
• younger boy:
sideropenic anemias