Recurrent Juvenile Nasopharyngeal Angiofibroma: Two Cases Emphasizing the Role of Follow-Up and Staging in Surgical Planning.

BACKGROUND

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign but locally aggressive vascular tumor affecting adolescent males. While endoscopic resection with preoperative embolization remains the treatment of choice, recurrence remains a challenge, often driven by incomplete excision or poor follow-up adherence.

CASE PRESENTATION: We report two cases of recurrent JNA in adolescent males, each highlighting a different modifiable risk factor for recurrence. Case 1 involved a 21-year-old with prior resection and poor postoperative follow-up, who re-presented with Radkowski Stage IIIA disease involving the central skull base. Case 2 involved an 18-year-old initially misdiagnosed with a nasal polyp, later confirmed as JNA after recurrence within 4 months of surgery. Both patients underwent preoperative embolization followed by endoscopic endonasal resection using a transnasal-transpterygoid approach. Histopathology confirmed recurrent JNA in both cases. Postoperative MRI at 3 months showed no evidence of residual or recurrent disease.

CONCLUSION

These cases underscore the critical role of accurate initial diagnosis, proper staging, and structured postoperative surveillance in reducing recurrence risk in JNA. Multidisciplinary care, patient education, and imaging-guided follow-up protocols are essential, especially in resource-constrained settings where diagnostic delays and adherence challenges are prevalent.