Juvenile Nasopharyngeal Angiofibroma With Sphenoid Sinus Invasion and Protrusion: Treatment Approach With Le Fort I Osteotomy.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor that occurs predominantly in young males. The authors report the case of a 22-year-old male patient who presented with a painless, exophytic tumor mass protruding through the right nostril, with anterior lateral extension associated with severe posterior involvement, erosion of the sphenoid bone to the right of the pterygoid process, and significant epistaxis. The preoperative evaluation, surgical approach, postoperative results, and a review of the literature are presented. The surgical approach with Le Fort I osteotomy was designed to facilitate surgical access to the tumor in the nasal cavity. Before down-fracture of the maxilla, plates were placed for fixation and holes were made to produce reference points for restoration of normal anatomy after tumor removal. Although the literature describes the use of nonsurgical therapies, it is well established that surgical treatment is the best option for patients with JNA. Treatment also requires preoperative embolization to avoid bleeding and ensure safety during tumor resection. Long-term imaging follow-up every 6 to 8 months for at least 3 years after surgery is needed for detection of residual tumor/recurrence. The modified technique used here together with preoperative embolization was essential to successful outcome.