Juvenile nasopharyngeal angiofibroma

Rare but commonest benign nasopharyngeal tumor.

Aetiology

probably testestorone appearance in an adolescent male [10-20 age] causes the hamartomatous nidus of vascular tissue in postnasal cavity near sphenopalatine foramen, to activate into angiofibroma which is fibrovascular pink-purple sessile firm locally-invasive mass without muscle coat, hence bleeding can’t be controlled by vasoconstrictors/adrenaline.

CFs :

1. nasal cavity obstruction [1 or both choana] -
   • recurrent profuse epistaxis [marked anaemia]
   • discharge
   • denasal speech
2. ET obstr – conductive deafness, serous otitis media
3. invasive destruction of PNS [max, sph, eth] – swelled cheek
4. pterygomax & infratemporal fossa – broad nasal bridge
5. enters inf/sup orbital fissure & destroys orbit apex – proptosis, frog face deformity
6. thr sphoid sinus into middle cranial cavity, thr ethmoid roof into anterior cranial cavity – involvement of CN 2,3,4,5

Δ : only from CFs, palpation should be done only during surgery since profuse bleeding[2l]

Biopsy [for D/D: teratoma, hemartoma, pleomorphic adenoma, chordoma, choristoma, paraganglioma] only under general anaesthesia with bleeding control arrangements & blood transfusion.

• Xray -
  • lateral nasopharynx – soft tissue mass
  • PNS – opaque sinuses, deviated nasal septum, anterior bowing/destruction of posterior max sinus wall.
  • Skull base – erosion of sphenoid Gwing & pterygoid plates, widenned lower lateral margin of superior orbital fissure
• CT scan – esp intracranial extensions
• Carotid angiography – extensions & feeding vessels

Rx : Surgical resection :
preoperative ↓ vascularity – stilbEsterol, radiation, cryotherapy, embolise feeding bv.

• transpalatal type – for nasopharyngeal tumor
• lateral rhinotomy type – for extended tumor

Advertisement