Resection of Juvenile Nasopharyngeal Angiofibroma Using Le Fort I Approach and Deep Hypothermic Circulatory Arrest

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, highly vascular benign tumor that predominantly affects adolescent males. Despite its benign histology, JNA may exhibit aggressive behavior, often invading adjacent anatomic regions, such as the skull base, orbit, and intracranial space, which complicates surgical management due to the risk of severe hemorrhage. The authors report the case of a 13-year-old male with recurrent JNA (Andrews IVB, Chandler IV, Radkowski IIIB) presenting with left-eye amaurosis and a 2-year history of tracheostomy. Imaging confirmed extensive tumor involvement. Preoperative embolization was performed, followed by surgical resection through a Le Fort I osteotomy combined with deep hypothermic circulatory arrest (DHCA) at 19°C for 35 minutes. Extracorporeal circulation was established through femoral arterial and venous cannulation, with controlled rewarming after tumor removal. The surgery was carried out by a multidisciplinary team including maxillofacial, neurosurgical, and cardiovascular specialists. Intraoperative cell salvage minimized the need for blood transfusion. Postoperative care in the intensive care unit was uneventful, and a secondary intervention confirmed complete hemostasis. This case illustrates the potential of combining Le Fort I osteotomy with DHCA to achieve safe and effective resection of extensive JNA, offering excellent hemostatic control and favorable clinical outcomes. Multidisciplinary collaboration and careful perioperative planning are essential in managing such complex cases.