Recurrent Juvenile Nasopharyngeal Angiofibroma: Two Cases Emphasizing the Role of Follow-Up and Staging in Surgical Planning.

Abstract

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign but locally aggressive vascular tumor affecting adolescent males. While endoscopic resection with preoperative embolization remains the treatment of choice, recurrence remains a challenge, often driven by incomplete excision or poor follow-up adherence.

Case presentation: We report two cases of recurrent JNA in adolescent males, each highlighting a different modifiable risk factor for recurrence. Case 1 involved a 21-year-old with prior resection and poor postoperative follow-up, who re-presented with Radkowski Stage IIIA disease involving the central skull base. Case 2 involved an 18-year-old initially misdiagnosed with a nasal polyp, later confirmed as JNA after recurrence within 4 months of surgery. Both patients underwent preoperative embolization followed by endoscopic endonasal resection using a transnasal-transpterygoid approach. Histopathology confirmed recurrent JNA in both cases. Postoperative MRI at 3 months showed no evidence of residual or recurrent disease.

Conclusion: These cases underscore the critical role of accurate initial diagnosis, proper staging, and structured postoperative surveillance in reducing recurrence risk in JNA. Multidisciplinary care, patient education, and imaging-guided follow-up protocols are essential, especially in resource-constrained settings where diagnostic delays and adherence challenges are prevalent.