Repair oronasal fistula in a treated juvenile nasopharyngeal angiofibroma patient.

Abstract

The juvenile nasopharyngeal angiofibroma (JNA) is a benign neoplasm that affects mostly young males. Preoperative embolisation is an accepted treatment to reduce perioperative bleeding, however, severe complications may accompany these invasive procedures. One 14-year-old JNA patient with severe epistaxis was transferred to us for treatment. Unfortunately, a left middle cerebral artery infarction occurred during the embolisation procedure. Right side hemiplegia and left eye blindness were noted. Nine months later, another course of embolisation and surgical treatment was performed, but the presence of one oronasal fistula was noted after the JNA was successfully excised. A free radial forearm flap was selected to reconstruct the palate. Angiography and embolisation carry the risks of accidental infarction. Oronasal fistula may occur when incising through the 'embolized palate'. Possible complications should be discussed with the families in advance. In the case of complications, the medical team should cooperate and try to prevent morbidity.