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Recurrence of Juvenile Angiofibroma and its Prevention

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Juvenile Angiofibroma

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Abstract

At present, the treatment of choice for juvenile angiofibroma (JA) is surgery, which has evolved to endoscopic approaches, performed at referral centers.

The epicenter of JA is located in the sphenopalatine foramen, and its patterns of extension are medial and lateral, complicated due to the deep location of the structures involved and close proximity to critical vascular and neural elements.

These facts frequently predispose to incomplete tumor resection and disease recurrence, especially in advanced stages and extensive lateral invasion patterns (INCan stage IIB and more advanced). The majority of series report a mean recurrence rate of 35 %, mostly in advanced stages.

Several prognostic factors have been described that predispose to recurrence, in addition to advanced stages and extensive lateral dissemination in the central skull base. These additional factors include blood loss, tumor size, surgical margins, the expertise of the surgical team – the latter closely related with a rational application of endoscopic approaches for resection – and nonsurgical treatment.

Consequently, a rational design of the treatment strategy should be performed from the first surgical attempt, based on surgical expertise, comprising the use of endoscopy in medial and minor lateral extensions, and the utilization of open surgical approaches such as osteoplastic maxillotomy (medial and anterolateral), according to the major invasion of tumors. In very advanced cases, a maxillotomy or neuro-otological procedure (Fisch C), combined with an anterolateral and/or transtemporal neurosurgical approach, should be carried out. Radiotherapy is used for multiple recurrences and in major medial encasement of the cavernous sinus and carotid artery (INCan stage IVb).

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Authors and Affiliations

  1. Departamento de Tumores de Cabeza y Cuello, Mexico, Mexico

    José F. Carrillo MD

  2. Head and Neck Department, Instituto Nacional de Cancerología, Av. San Fernando 22, Deleg. Tlalpan, 14080, México, DF, Mexico

    José F. Carrillo MD

  3. Subdirección de Investigación Clínica, Mexico, Mexico

    Liliana C. Carrillo MD

  4. Departamento de Farmacología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, Mexico

    Margarita Ramirez-Ortega PhD

Authors
  1. José F. Carrillo MD
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  2. Liliana C. Carrillo MD
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  3. Margarita Ramirez-Ortega PhD
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Correspondence to José F. Carrillo MD .

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Editors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Port Moresby General Hospital and School of Medicine and Health Sciences, University of Papua New Guinea, Boroko Port Moresby, Papua New Guinea

    Siba P. Dubey

  2. Department of Otolaryngology-Head and Neck Surgery, University of Saarlands Medical Center, Homburg/Saar, Saarland, Germany

    Bernhard Schick

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Carrillo, J.F., Carrillo, L.C., Ramirez-Ortega, M. (2017). Recurrence of Juvenile Angiofibroma and its Prevention. In: Dubey, S., Schick, B. (eds) Juvenile Angiofibroma. Springer, Cham. https://doi.org/10.1007/978-3-319-45343-9_20

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  • DOI: https://doi.org/10.1007/978-3-319-45343-9_20

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-45341-5

  • Online ISBN: 978-3-319-45343-9

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