JUVENILE NASOPHARYNGEAL ANGIOFIBROMA: A CASE REPORT

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