{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T17:58:52Z","timestamp":1765994332505},"reference-count":27,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2016,3,4]],"date-time":"2016-03-04T00:00:00Z","timestamp":1457049600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Laryngol. Otol."],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0022215116000773_sec_a1\"><jats:title>Background:<\/jats:title><jats:p>Juvenile nasopharyngeal angiofibroma often presents with lateral extensions. In countries with limited resources, selection of a cost-effective and least morbid surgical approach for complete excision is challenging.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215116000773_sec_a2\"><jats:title>Methods:<\/jats:title><jats:p>Sixty-three patients with juvenile nasopharyngeal angiofibroma, with lateral extensions, underwent transpalatal, transpalatal-circumaxillary (transpterygopalatine) or transpalatal-circumaxillary-sublabial approaches for resection. Clinico-radiological characteristics, tumour volume and intra-operative bleeding were recorded.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215116000773_sec_a3\"><jats:title>Results:<\/jats:title><jats:p>The transpalatal approach was suitable for extensions involving medial part of pterygopalatine fossa; transpalatal-circumaxillary for extensions involving complete pterygopalatine fossa, with or without partial infratemporal fossa; and transpalatal-circumaxillary-sublabial for extensions involving complete infratemporal fossa, even cheek or temporal fossa up to zygomatic arch. Haemorrhage was greatest with the transpalatal-circumaxillary-sublabial approach, followed by transpalatal approach and transpalatal-circumaxillary approach (1212, 950 and 777 ml respectively). Tumour size (volume) was greatest with the transpalatal-circumaxillary approach, followed by transpalatal-circumaxillary-sublabial approach and transpalatal approach (40, 34 and 29 mm<jats:sup>3<\/jats:sup>). There was recurrence in three cases and residual disease in two cases. Long-term morbidity included small palatal perforation (<jats:italic>n<\/jats:italic> = 1), trismus (<jats:italic>n<\/jats:italic> = 1) and atrophic rhinitis (<jats:italic>n<\/jats:italic> = 2).<\/jats:p><\/jats:sec><jats:sec id=\"S0022215116000773_sec_a4\"><jats:title>Conclusion:<\/jats:title><jats:p>These modified techniques, performed with endoscopic assistance under hypotensive anaesthesia, without embolisation, offer a superior option over other open procedures with regard to morbidity and recurrences.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0022215116000773","type":"journal-article","created":{"date-parts":[[2016,3,4]],"date-time":"2016-03-04T06:34:57Z","timestamp":1457073297000},"page":"462-473","source":"Crossref","is-referenced-by-count":12,"title":["In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma"],"prefix":"10.1017","volume":"130","author":[{"given":"A","family":"Mishra","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S C","family":"Mishra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V","family":"Verma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H P","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A 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