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Contemporary management of juvenile angiofibroma

Bertazzoni, Giacomo; Schreiber, Alberto; Ferrari, Marco; Nicolai, Piero

Current Opinion in Otolaryngology & Head and Neck Surgery: February 2019 - Volume 27 - Issue 1 - p 47–53
doi: 10.1097/MOO.0000000000000505
NOSE AND PARANASAL SINUSES: Edited by Samuel S. Becker and Nithin D. Adappa
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Purpose of review To illustrate the latest developments and trends in the management of juvenile angiofibroma.

Recent findings Endoscopic surgery is currently the primary management strategy for juvenile angiofibroma. Recent reports on the use of multiportal approaches have contributed to further extend its indications. Studies from different countries suggest that the lesion can display variable growth rates not only in relation to patient age. The same concept applies to residual lesions. For this reason, retreatment of persistent juvenile angiofibromas is indicated when serial imaging clearly shows that the lesion is growing. When redo surgery is potentially associated with high morbidity for the critical relationships of the lesion with adjacent structures, stereotactic or intensity-modulated radiation therapy can be an alternative. Early use of MRI in the postoperative course is a highly effective way to detect residual lesions.

Summary Contemporary management of juvenile angiofibroma should primarily rely on endoscopic surgery to obtain radical tumor resection. Recent evidence on the behavior of residual postoperative juvenile angiofibroma and the development of conformal RT techniques have helped to clarify the role of watchful waiting and radiotherapy (RT) as alternatives to aggressive procedures in cases with critical extension of the lesion. Although radical excision is the primary therapeutic objective, the benign nature of juvenile angiofibroma and the reported tendency of small residual lesions to remain stable or involute, especially in postpubertal patients, should always be kept in mind to avoid unnecessary morbidity.

Video abstract In the video, two of the authors describe the content of the review and present the main topics discussed in the article. http://links.lww.com/COOH/A37.

Unit of Otorhinolaryngology – Head and Neck Surgery, University of Brescia, Brescia, Italy

Correspondence to Giacomo Bertazzoni, MD, Unit of Otorhinolaryngology, University of Brescia, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. Tel: +39 030 3995322; e-mail: ilbertaz@gmail.com

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