Nasopharyngeal angiofibroma is a histologically benign but locally aggressive vascular tumor of the nasopharynx that arises from the superior margin of the sphenopalatine foramen and grows in the back of the nasal cavity. It most commonly affects adolescent males. Though it is a benign tumor, it is locally invasive and can invade the nose, cheek, orbit, or brain. Patients with nasopharyngeal angiofibroma usually present with one-sided nasal obstruction with profuse epistaxis.
If nasopharyngeal angiofibroma is suspected based on physical examination, imaging studies such as CT or MRI should be performed. Biopsy should be avoided as to avoid extensive bleeding since the tumor is composed ofblood vessels without a muscular coat. Antral sign or Holman-Miller sign is pathognomic of angiofibroma. DSA of carotid artery to see the extension of tumors and feeding vessels
Treatment for Nasopharyngeal angiofibroma is primarily surgical. The tumor is primarily excised by external or endoscopic approach. Medical treatment and radiation therapy are only of historical interest. External approaches:
transpalatine approach
transpalatine + sublabial Approach
infratemporal Approach
nasal endoscopic Approach
transmaxillary Approach
maxillary swing Approach or Facial translocation
Endoscopic approach is an excellent tool in primary and recurrent JNA, it allows visualisation and precise removal of the lesion. Preoperative embolisation of tumour may be of some use in reducing intraoperative bleeding. Direct visualization is not common.
If the tumor is limited to nasopharynx and nose, for endoscopic approach or Wilson's transpalatal approach is used. It can be extended into Sardana's approach if the tumor extends laterally.
If the tumor extend up to the cheek, for Weber–Ferguson approach should be used.
Prognosis
Prognosis for nasopharyngeal angiofibroma is favorable. Because these tumors are benign, metastasis to distal sites does not occur. However, these tumors are highly vascularized and grow rapidly. Removal is important in preventing nasal obstruction and recurrent epistaxis. Mortality is not associated with nasopharyngeal angiofibroma.
