Mojtaba Mohammadi Ardehali - Otorhinolaryngology Research Center, Amir Alam Educational Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Seyed Hadi Samimi - Otorhinolaryngology Research Center, Amir Alam Educational Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mehdi Bakhshaee - Sinus and Surgical Endoscopic Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Introduction: In recent years, the surgical management of angiofibroma has been greatly influenced by the use of endoscopic techniques. However, large tumors that extend into difficult anatomic sites present major challenges for management by either endoscopy or an open-surgery approach which needs new technique for the complete en block resection.   Materials and Methods: In a prospective observational study we developed an endoscopic transnasal technique for the resection of angiofibroma via pushing and pulling the mass with ۱/۱۰۰۰۰۰ soaked adrenalin tampons. Thirty two patients were treated using this endoscopic technique over ۷ years. The mean follow-up period was ۳۶ months. The main outcomes measured were tumor staging, average blood loss, complications, length of hospitalization, and residual and/or recurrence rate of the tumor.   Results: According to the Radkowski staging, ۲۳,۵, and ۴ patients were at stage IIC, IIIA, and IIIB, respectively. Twenty five patients were operated on exclusively via transnasal endoscopy while ۷ patients were managed using endoscopy-assisted open-surgery techniques. Mean blood loss in patients was ۱۲۶۱± ۸۹۳ cc. The recurrence rate was ۲۱.۸۸% (۷ cases) at two years following surgery. Mean hospitalization time was ۳.۵۶ ± ۰.۶ days.   Conclusion:  Using this effective technique, endoscopic removal of more highly advanced angiofibroma is possible. Better visualization, less intraoperative blood loss, lower rates of complication and recurrence, and shorter hospitalization time are some of the advantages.