To study the clinical profile of nasopharyngeal angiofibromas, various surgical approaches, and the outcome of surgery.The retrospective study was carried out in 110 consecutive cases of nasopharyngeal angiofibroma over a period of 25 years.A hospital-based study.In 65 patients, a transpalatal approach was used, and in 38 patients, a lateral rhinotomy approach was used. The tumour was removed by external ethmoidectomy in 2 cases and in by transnasal approach in 3 cases. A modification of the transpalatal approach was also designed.Patients were regularly followed up for any recurrence for 2 to 5 years.Of 118 operated cases, in 33 patients, recurrence was observed. Four cases had to be operated three times and one case four times. All of the recurrences were observed within 2 years.Angiofibroma, a disease of adolescent males, arises from either the lateral wall or the roof of the nasopharynx. Patients usually present at the late stage of the disease. Surgery is the treatment of choice. No single approach is applicable to all cases. However, most of the tumours are excisable by a lateral rhinotomy approach, with less chance of recurrence. The modified transpalatal approach provides excellent exposure. Recurrence occurs within 2 years.