We read with interest the article by Radkowski et al1 concerning angiofibroma. We would agree that the combined transpalatal and transantral approach allows limited access to the superolateral areas of potential tumor spread and that for the more extensive juvenile nasopharyngeal angiofibroma a wider exposure is required. The midfacial degloving incision allows an excellent cosmetic result on the skin, but this approach has the significant disadvantage of destroying the anterior maxillary bone in the lateral alar region, which is of particular importance in the growing facial skeleton and dentition. The authors comment that there was no evidence of disturbance of midface growth in an average follow-up of 6 years; it would be interesting to know the median follow-up and what parameters were used to assess facial growth. Our experience has indicated considerable ipsilateral nasal base collapse with delay or absent eruption of the permanent canine tooth or local abnormalities
Mellor TK, Malins TJ. Transfacial Surgical Access in the Treatment of Angiofibroma. Arch Otolaryngol Head Neck Surg. 1997;123(1):115–116. doi:10.1001/archotol.1997.01900010125022
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