Denker Operation is an Effective Surgical Approach in Managing Juvenile Nasopharyngeal Angiofibroma

This article presents our experience with the various surgical approaches for angiofibroma and establishes the Denker procedure as an effective approach for removal of the tumor. The medical records of 29 patients treated between the years 1981 and 2001 were examined. The clinical extent of the tumor, the surgical approach, complications, and recurrences were evaluated. The surgical approaches used before 1992 consisted of the transnasal, transpalatal, and combined transnasal-transpalatal ones. Although no major recurrence or major morbidity was observed, late complications occurred, such as persistent palatal fistula in 3 patients who underwent operation via a transpalatal approach, and an unsightly scar with lacrimal duct stenosis in 2 patients who underwent operation via a combined transnasal-transpalatal approach. From 1992 onward, the above-mentioned surgical approaches were replaced with the Denker and midfacial degloving techniques, which proved to be just as effective in removing the tumor and did not produce late complications. According to our experience, the Denker approach is effective for angiofibromas confined to the nasal cavity and nasopharynx with small extensions in the infratemporal fossa. On the other hand, large tumor extension in the infratemporal fossa can be effectively approached in combination with a midfacial degloving technique.