Juvenile nasopharyngeal angiofibroma: nationwide study on incidence, diagnosis, treatment, and recurrence

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumour affecting adolescent males, originating near the sphenopalatine foramen and often expanding aggressively. This nationwide study examines the clinical presentation, treat-ment, and prognosis of patients diagnosed from 2003 until mid-2022. Methods: Patients were identified in the national pathology database. The Kaplan-Meier estimator calculated event-free survival, and t-test and Fisher's exact test compared variables. The incidence rates were determined using the 2000 World Health Organization World Standard Population. Results: Sixty-one male patients were included (median age: 16.5 years). The national incidence was 0.12 per 100,000 male person-years (0.43 per 100,000 men at risk (10-24 years)). Common symptoms included nasal obstruction (90%) and epistaxis (59%). Predominant tu-mour stages were Radkowski IIB (31.3%) and Chandler III (65%). Most patients (97%) underwent preoperative embolization, with image-guided endoscopic sinus surgery (ESS) as the primary treatment (86%). Median intraoperative blood loss (IBL) was 500 mL. Radkowski staging correlated with IBL, tumour devascularization, and internal carotid artery (ICA) blood supply. No major complications occurred. Recurrence (25%) was associated with Chandler stage III-IV, with a two-year recurrence-free survival rate of 77%. Conclusions: Tumour stage correlated with IBL, tumour devascularization, and ICA supply. Recurrence mainly occurred within two years post-surgery, exclusively in advanced-stage cases. With close collaboration between interventionists and rhinologists, preoperative embolization followed by image-guided ESS is recommended as a safe approach with minimal risks.