{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T01:59:55Z","timestamp":1791165595873,"version":"4.1.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002386","name":"Cairo University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002386","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>To detect risk factors and common anatomical sites for recurrence of juvenile nasopharyngeal angiofibroma (JNA).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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 (\u2265\u20094\u00a0cm), 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\u2019t undergo preoperative embolization or had a primary tumor size\u2009&lt;\u20094\u00a0cm had significantly longer recurrence interval than those with advanced tumor stage or underwent preoperative embolization or had a primary tumor size\u2009\u2265\u20094\u00a0cm. 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%).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00405-025-09476-9","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T16:00:11Z","timestamp":1748966411000},"page":"3611-3618","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Recurrent angiofibroma: analysis of risk factors and common sites of recurrence"],"prefix":"10.1007","volume":"282","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7175-8666","authenticated-orcid":false,"given":"Hisham Mohamed Anwar","family":"Attya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Salah","family":"Hassouna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9497-7113","authenticated-orcid":false,"given":"Abdelrahman Ali","family":"Shawky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mena Esmat","family":"Abdelmalek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"issue":"4","key":"9476_CR1","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1002\/lary.23843","volume":"123","author":"Z Boghani","year":"2013","unstructured":"Boghani Z, Husain Q, Kanumuri VV, Khan MN, Sangvhi S, Liu JK, Eloy JA (2013) Juvenile nasopharyngeal angiofibroma: a systematic review and comparison of endoscopic, endoscopic-assisted, and open resection in 1047 cases. Laryngoscope 123(4):859\u2013869","journal-title":"Laryngoscope"},{"issue":"5","key":"9476_CR2","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1007\/s00405-023-07824-1","volume":"280","author":"M Jurlina","year":"2023","unstructured":"Jurlina M, Pupi\u0107-Bakra\u010d J, Pupi\u0107-Bakra\u010d A (2023) Endoscopic, endoscopic-assisted and open approaches in the treatment of juvenile angiofibroma: what has been new in the past decade (and 1586 cases)? Eur Arch Otorhinolaryngol 280(5):2081\u20132089","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"5","key":"9476_CR3","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1097\/00005537-200305000-00003","volume":"113","author":"P Nicolai","year":"2003","unstructured":"Nicolai P, Berlucchi M, Tomenzoli D, Cappiello J, Trimarchi M, Maroldi R, Battaglia G, Antonelli AR (2003) Endoscopic surgery for juvenile angiofibroma: when and how. Laryngoscope 113(5):775\u2013782","journal-title":"Laryngoscope"},{"issue":"06","key":"9476_CR4","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1055\/s-0038-1676562","volume":"80","author":"C Reyes","year":"2019","unstructured":"Reyes C, Bentley H, Gelves JA, Solares CA, Byrd JK (2019) Recurrence rate after endoscopic vs. open approaches for juvenile nasopharyngeal angiofibroma: a meta-analysis. J Neurol Surg Part B: Skull Base 80(06):577\u2013585","journal-title":"J Neurol Surg Part B: Skull Base"},{"issue":"2","key":"9476_CR5","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1097\/00005537-200402000-00020","volume":"114","author":"WJ Mann","year":"2004","unstructured":"Mann WJ, Jecker P, Amedee RG (2004) Juvenile angiofibromas: changing surgical concept over the last 20 years. Laryngoscope 114(2):291\u2013293","journal-title":"Laryngoscope"},{"issue":"4","key":"9476_CR6","doi-asserted-by":"publisher","first-page":"364","DOI":"10.21053\/ceo.2022.01053","volume":"15","author":"R Fang","year":"2022","unstructured":"Fang R, Sun W, Shi J, Xu R, Peng L, Lai Y, Chen F, Wen Y, Wen W, Li J (2022) Risk factors and characteristics of the recurrence of juvenile nasopharyngeal angiofibroma: A 22-Year experience with 123 cases at a tertiary center. Clin Exp Otorhinolaryngol 15(4):364","journal-title":"Clin Exp Otorhinolaryngol"},{"issue":"3","key":"9476_CR7","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.ijporl.2008.11.005","volume":"73","author":"R Midilli","year":"2009","unstructured":"Midilli R, Karci B, Akyildiz S (2009) Juvenile nasopharyngeal angiofibroma: analysis of 42 cases and important aspects of endoscopic approach. Int J Pediatr Otorhinolaryngol 73(3):401\u2013408","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"9476_CR8","doi-asserted-by":"crossref","unstructured":"Nicolai P, Schreiber A, Bolzoni Villaret A (2012) Juvenile angiofibroma: evolution of management. International Journal of Pediatrics, 2012","DOI":"10.1155\/2012\/412545"},{"key":"9476_CR9","unstructured":"Sun XC, Wang DH, Yu HP, Wang F, Wang W, Jiang JJ (2010) Analysis of risk factors associated with recurrence of nasopharyngeal angiofibroma. J Otolaryngology\u2013Head Neck Surg, 39(1)"},{"key":"9476_CR10","doi-asserted-by":"crossref","unstructured":"Janakiram TN, Sharma SB, Kasper E, Deshmukh O, Cherian I (2017) Comprehensive preoperative staging system for endoscopic single and multicorridor approaches to juvenile nasal angiofibromas. Surgical Neurology International, 8","DOI":"10.4103\/sni.sni_295_16"},{"issue":"11","key":"9476_CR11","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1017\/S0022215118001779","volume":"132","author":"AE Pamuk","year":"2018","unstructured":"Pamuk AE, \u00d6zer S, S\u00fcsl\u00fc AE, Akg\u00f6z A, \u00d6nerci M (2018) Juvenile nasopharyngeal angiofibroma: a single centre\u2019s 11-year experience. J Laryngology Otology 132(11):978\u2013983","journal-title":"J Laryngology Otology"},{"issue":"3","key":"9476_CR12","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.amjoto.2018.11.010","volume":"40","author":"Z Liu","year":"2019","unstructured":"Liu Z, Hua W, Zhang H, Wang J, Song X, Hu L, Lu H, Wang D (2019) The risk factors for residual juvenile nasopharyngeal angiofibroma and the usual residual sites. Am J Otolaryngol 40(3):343\u2013346","journal-title":"Am J Otolaryngol"},{"key":"9476_CR13","unstructured":"McCombe A, Lund VJ, Howard DJ (1990) Recurrence in juvenile angiofibroma. Rhinology, 28(2)"},{"issue":"7","key":"9476_CR14","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1002\/lary.30616","volume":"133","author":"A Diaz","year":"2023","unstructured":"Diaz A, Wang E, Bujnowski D, Arimoto R, Armstrong M, Cyberski T, Nordgren R, Seal SM, Kass-Hout T, Roxbury C (2023) Embolization in juvenile nasopharyngeal angiofibroma surgery: A systematic review and Meta\u2010Analysis. Laryngoscope 133(7):1529\u20131539","journal-title":"Laryngoscope"},{"key":"9476_CR15","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1007\/s12070-016-1014-0","volume":"68","author":"N Janakiram","year":"2016","unstructured":"Janakiram N, Sharma SB, Panicker VB, Srinivas CV (2016) A drastic aftermath of embolisation in juvenile nasopharyngeal angiofibroma. Indian J Otolaryngol Head Neck Surg 68:540\u2013543","journal-title":"Indian J Otolaryngol Head Neck Surg"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-025-09476-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-025-09476-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-025-09476-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T17:26:45Z","timestamp":1757179605000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00405-025-09476-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":15,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["9476"],"URL":"https:\/\/doi.org\/10.1007\/s00405-025-09476-9","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,3]]},"assertion":[{"value":"19 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Research Ethics Committee of the Faculty of Medicine, Cairo University on 29-8-2022 under the code of MD-221-2022.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"There are no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}