Five challenging presentations of juvenile nasopharyngeal angiofibroma: our experience in the diagnosis and endoscopic surgical management.

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor originating from the pterygopalatine fossa and is the most common lesion of the nasopharynx. Its hypervascularity and complex anatomical extensions make selecting the most effective surgical approach intricate. All patients in this series were males, and their age ranged between 8 and 23 years. Extensions to the carotids, cavernous sinus, and infratemporal fossa were noted. In addition, intraoperative details with particular emphasis on the endoscopic two-surgeon transseptal approach were discussed. Nasal obstruction was the most reported symptom, whereas epistaxis was evident in two cases. Complete or near-complete resection of the tumor was achieved in all cases. Over the follow-up period, one patient underwent successful revision endoscopic excision after tumor regrowth. JNA can be completely excised with endoscopic techniques. For large tumors, creating a wider window by using a two-surgeon trans-septal approach is practical and defers the need for external resection.