유년성 혈관섬유종의 임상적 분석

Juvenile angiofibroma is a rare head and neck tumor which is characterized by high vascularity, predominance in adolescence, aggressive growth with surrounding tissue destruction, and high recurrence. We retrospectively reviewed 22 cases of juvenile angiofibromas operated at Pusan National University Hospital from January 1982 to October 1997 to analyze the clinical behavior, effect of preoperative embolization, indication of different surgical approach according to Sesson's tumor staging, operative findings, and results of postoperative follow-up to help for establishing treatment modalities of angiofibroma. Frequent epistaxis and nasal obstruction were most common symptoms. Most angiofibromas originated from posterior-superior-lateral wall of nasal cavity, attaching to posterior wall of nasopharynx and posterior nasal septum. Sphenoid sinus and pterygomaxillary fossa were common extension sites. The main feeding vessels were branches of ipsilateral internal maxillary artery, especially sphenopalatine artery as terminal branch. In Sesson's stage I transpalatal, transnasal, endonasal endoscopic, Denker's, lateral rhinotomy approach were applied in order. In stage II lateral rhinotomy, endonasal endoscopic, transpalatal, maxillary swing approach applied. Recurrence was each 1 case of I_B and II_A (9.0%). Preoperative embolization did not reduce intraoperative blood loss. However, endonasal endoscopic surgery reduced bleeding amount significantly, suggesting that much of blood loss occurred from bone and adjacent structure during extranasal surgical approach. Our results of endonasal endoscopic removal suggest that stage I_A, I_B, II_A are good indications for endoscopic surgery and can be further extended to stage II_B.