A Case of Juvenile Angiofibroma Invading Pterygopalatine Fossa, Infratemporal Fossa and Lateral Skull Base Treated by Combined Endoscopic Trans-Binasal and Endoscopic Sublabial-Transmaxillary Approach

Recently, transnasal endoscopic surgery of nasopharyngeal angiofibroma has been extensively used as an excellent alternative to external approaches in the management of small-intermediate size nasopharyngeal angiofibroma. But if tumor has extended to the pterygopalatine fossa or infratemporal fossa, transnasal endoscopic approach alone has limitations for complete removal. Combining transnasal and endoscopic sublabial-transmaxillary approach can be helpful for management of extremely lateral lesions of the pterygopalataine fossa, as well as the infratemporal fossa. We present a case of nasopharyngeal angiofibroma extended to pterygopalatine fossa, lateral skull base and infratemporal fossa, which was successfully removed by combined endoscopic trans-binasal and endoscopic sublabial-transmaxillary approach using three holes-six hands technique. (J Clinical Otolaryngol 2012;23:283–288)