JUVENILE NASOPHARYNGEAL ANGIOFIBROMA: A CASE REPORT

Abstract

Juvenile Nasopharyngeal Angiofibroma is a rare benign neoplasm almost exclusively seen in adolescent
males, which proliferates under the influence of steroid hormones at puberty. It arises from the margin
of sphenopalatine foramen and spreads widely along the skull base. Histologically, it comprises a
hamartomatous tumor of vascular tissue lacking smooth muscle and elastic coats. Its propensity to bleed
heavily and extensive spread along the skull base and cranial fossae pose significant risk of hemorrhage
during surgical resection. Various techniques are employed before and during surgery to reduce the risk
of per-operative hemorrhage. Advances in interventional radiology such as pre-operative embolization
of feeder vessels enable safer resection. We present a case of a 15-year old male admitted with triad of
nasal obstruction, recurrent spontaneous epistaxis and fleshy mass in right nasal cavity. HRCT paranasal
sinuses revealed a large nasopharyngeal mass infiltrating the nasal cavity, the nasopharynx, sphenoid
sinus, and bilateral posterior ethmoidal cells, extending up to the infratemporal fossa. Cross-sectional
imaging enabled accurate staging and open surgical technique was opted. Pre-operative embolization of
internal maxillary artery allowed successful complete surgical resection with minimal bleeding per
operatively. With accurate staging and correct choice of hemostatic technique, angiofibroma can be
excised completely with relatively less morbidity