Objective: To explore the feasibility of treatment on angiofibroma patients with stage III, IV by midfacial degloving approach and modified maxillectomy.
Method: From Feb. 2001 to Aug. 2004, midfacial degloving approach and modified maxillectomy was used for treating 7 angiofibroma patients with stage III, IV. Using Fisch stage: Five cases were in stage III, 2 cases were stage IV; 2 cases with stage III accepted midfacial degloving approach and modified maxillectomy. Five cases accepted midfacial degloving approach and Le fort I approach (stage III, 3 cases; stage IV, 2 cases). One patient accepted the combined therapy of facial approach and cranium approach. 6 cases accept the embolization of the artery which feed the tumor (2 cases in stage IV, 4 cases in stage III).
Result: The blood loss was (600 +/- 324) ml in operation, the blood loss in operation of patients with selective preoperative embolization was (483 +/- 165) ml. The blood loss of one case with no selective preoperative embolization was 1300 ml. The operating time was 129 +/- 22 min. The pathology of 7 cases was nasopharyngeal angiofibroma. For 30 to 72 months follow-up, No tumor recurrence were observed, one case in stage III accepted the selective preoperative embolization got the tumor recurrence 1 year after the surgery. After the second surgery, no tumor recurrence were seen till now.
Conclusion: For the patients in stage III, IV, midfacial degloving approach and modified maxillectomy is not only good for radical excision, curtating the operating time and blood loss, but also good for the cosmetic outlook and functional recovery. The selective preoperative embolization has a good significance on reducing the operating blood loss and tumor recurrence rate.