Mid-facial degloving for Juvenile Angiofibroma: A Case-Series of 21 Adult Males.
To describe the mid-facial degloving approach and compare the varying surgical approaches to juvenile angiofibromas. To demonstrate the efficacy of mid-facial degloving in treating large juvenile angiofibromas in a unique patient cohort.A retrospective case-series between 2006 and 2019.All patient care was undertaken at a regional skull base referral centre.21 male patients with a median age of 18 (range 16 – 45 years).Presenting symptoms, imaging, stage, age at operation, residual disease, estimated blood loss and operative time were all recorded. Post-operative outcomes included complications, length of stay and recurrence.The median surgical time was 105 minutes (range 55 – 219 minutes), median estimated blood loss 600 mls (range 150 – 900 mls) and median length of stay was 4 days (range 2 – 13 days.) Complications included two episodes of epistaxis, one requiring packing and one return to theatre. 14% (3/21) of patients had residual disease, none requiring further treatment and one patient had recurrence.MFD for JNA in our series resulted in low recurrence rate and no progression of residual disease. The approach has been successful in our cohort of patients and is an option in males over the age of 16 years, with JA extending beyond the nasopharynx and sinuses, involving the infratemporal fossa, cavernous sinus or orbital region.