Microsurgery in juvenile nasopharyngeal angiofibroma: a lateronasal approach with nasomaxillary pedicled flap.

Thirty-four consecutive juvenile nasopharyngeal angiofibromas, mainly stage II or III, were removed using a transnasomaxillary approach with good tumor control and without complications or sequelae. A pedicled nasomaxillary osteomucocutaneous flap is lifted through a lateronasal skin incision, and reflected laterally to open the nasal fossa and the maxillary sinus. This approach is an improvement on the conventional approach of lateral rhinotomy, which entails nasomaxillary skeletal loss. The approach ensures early and direct exposure of the root of the tumor and its vascular peduncle and also allows removal of tumors with intracranial extradural extensions.