- Angiofibroma of the Nasopharynx:
- Juvenile nasopharyngeal angiofibroma (JNA) occurs:
- In male teenagers
- Is a benign but locally aggressive tumor.
- The tumor contains:
- Both vascular and fibrous elements:
- Intermingling together
- Both vascular and fibrous elements:
- Juvenile nasopharyngeal angiofibroma (JNA) occurs:
- Epidemiology:
- Juvenile nasopharyngeal angiofibromas occur:
- Almost exclusively in males:
- Usually in adolescence:
- Approximately 15 years
- Usually in adolescence:
- Almost exclusively in males:
- They account for only 0.5% of all head and neck tumors:
- But are the most common of the benign nasopharyngeal neoplasms
- Juvenile nasopharyngeal angiofibromas occur:
- The patient presents with:
- Nasal obstruction and
- Epistaxis:
- One symptom usually predominates:
- This depends on the proportion of either of the two elements present:
- Recurrent epistaxis:
- Which can be severe:
- Is usually the presenting symptom
- Which can be severe:
- Recurrent epistaxis:
- This depends on the proportion of either of the two elements present:
- One symptom usually predominates:
- The origin of JNA:
- Is the posterolateral aspect of the roof of the nasal cavity:
- In the region of the sphenopalatine foramen
- When the tumor increases in size:
- It may extend into:
- The pterygopalatine fossa and then posteromedially into the nasopharynx or it may enlarge laterally into the infratemporal fossa
- Other routes of expansion include:
- Superiorly:
- Eroding the sphenoid sinus
- Anteriorly:
- Into the maxillary sinus.
- Growth into the orbit through the inferior orbital fissure:
- Will lead to proptosis
- In some cases extension superiorly into the middle cranial fossa
- Superiorly:
- It may extend into:
- Is the posterolateral aspect of the roof of the nasal cavity:
- On macroscopic examination:
- The angiofibroma is:
- Lobulated in appearance
- Its consistency ranges from:
- Spongy to a varying degree of firmness:
- Depending on the proportion of:
- Vascular tissue and fibrous component that forms the tumor
- Depending on the proportion of:
- Spongy to a varying degree of firmness:
- The angiofibroma is:
- Microscopically:
- Tumor is uncapsulated
- Formed by numerous blood vessels of varying calibre coursing through a fibrous tissue stroma
- The thickness of the muscular coat of these vessels varies and:
- In general elastic fibres in these vessels are lacking:
- Thus the ability to retract is reduced:
- This lack of contractile tissue is the pathological reason:
- For frequent episodes of epistaxis once a minor vessel starts to bleed
- This lack of contractile tissue is the pathological reason:
- Thus the ability to retract is reduced:
- In general elastic fibres in these vessels are lacking:
- These clinical features of repeated epistaxis and nasal obstruction in a male adolescent:
- Together with the finding of a vascular mass in the nasopharynx:
- Clinches the diagnosis
- Together with the finding of a vascular mass in the nasopharynx:
- Imaging studies are required:
- To confirm the diagnosis and to assess the extent of the tumor
- Plain radiographs:
- No longer play a role in the workup of a suspected juvenile nasopharyngeal angiofibroma:
- However:
- They may still be obtained in some instances during the assessment of nasal obstruction, or symptoms of sinus obstructions
- However:
- Findings include:
- Visualization of a nasopharyngeal mass
- Opacification of the sphenoid sinus
- Anterior bowing of the posterior wall of the maxillary antrum:
- Holman-Miller sign:
- Pathognomonic
- Holman-Miller sign:
- Widening of the pterygomaxillary fissure and pterygopalatine fossa
- Erosion of the base medial pterygoid plate
- No longer play a role in the workup of a suspected juvenile nasopharyngeal angiofibroma:
- Angiography reveals:
- Typical vascular tumor blush with multiple sources of blood supply and for large tumors bilateral supply is not uncommon:
- The internal maxillary artery and its branches are usually the principal feeder
- Typical vascular tumor blush with multiple sources of blood supply and for large tumors bilateral supply is not uncommon:
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