Recurrent angiofibroma: analysis of risk factors and common sites of recurrence.

Objective: To detect risk factors and common anatomical sites for recurrence of juvenile nasopharyngeal angiofibroma (JNA).

Methods: This is a retrospective study, included all male patients who were diagnosed histopathologically with juvenile nasopharyngeal angiofibroma (JNA) and were operated before at Kasr Al-Ainy Hospital, Cairo University in the period between January 2012 and December 2021. Their clinical data were retrieved and analyzed.

Results: Among 68 patients included in this study, 26 patients experienced recurrence with total recurrence rate (38.2%). JNA recurrence was significantly associated with primary tumor size (≥ 4 cm), advanced primary tumor stages (stage IIIa, IIIb according to Radkowski classification) and their correlatives of preoperative embolization, perioperative blood transfusion or open surgical approach. Age on presentation, tumor stage, perioperative blood transfusion and tumor size were significant factors affecting the recurrence rate according to cox regression univariate analysis, while on multivariate analysis the only significant independent predictors of JNA recurrence were age on presentation and tumor size. 61.53% of recurrent cases were discovered accidently through their regular postoperative follow up examination and/or imaging and were asymptomatic upon diagnosis of recurrence. Moreover, patients with early tumor stage or didn't undergo preoperative embolization or had a primary tumor size < 4 cm had significantly longer recurrence interval than those with advanced tumor stage or underwent preoperative embolization or had a primary tumor size ≥ 4 cm. Pterygoid process (92.3%) was significantly the commonest to be invaded by recurrent/residual tumor, followed by nasopharynx (84.6%) and sphenoid sinus (76.9%).

Conclusion: JNA recurrence is significantly associated with primary tumor size, primary tumor stage and their correlatives of preoperative embolization, perioperative blood transfusion or open surgical approach, but age on presentation and primary tumor size were the only independent predictors of tumor recurrence. Meticulous surgical attention should be paid for pterygoid process in order to decrease residual/recurrence incidence.