Juvenile Nasopharyngeal Angiofibroma: A Case Report

Abstract

A 18-year-old male presented with chief complains of nasal obstruction which was unilateral (left), progressive, epistaxis, continuing nasal discharge since two months, with a mass in his nasal cavity. He had intermittent headache which used to be relieved by simple analgesics with nasal bleeding episodes that lasted for 10-15 minutes actively and serous discharge pervasive over a two month period. On presentation, he had one episode of painless epistaxis, loosing approximately 40-50 ml of blood, for which he was referred to our centre. Past history reveals no episodes of nasal bleeding before two months but intermittent nasal discharge. Patient had no clinical pallor but mouth breathing was evident, specifically complained during sleep. Endoscopic examination of the nose reveals that the mass was congested, compressible, filling the left inferior and middle meatus, extending back filling the choana with active serous discharge with tinges of blood clots, probably from previous nasal bleed [Table/ Fig-1]. There was no tenderness on palpation and no external facial deformity. Probe test revealed no attachments in the nasal cavity. On posterior rhinoscopy the mass could be seen extending to nasopharynx in the region of fossa of rosenmuller and beyond.The oro-dental examination was normal. General examination revealed no significant abnormality. Routine haematological investigations were found to be within the normal limits. Fine-needle aspiration was carried out with caution in an operating room and revealed only blood. Computed tomography revealed a non-encapsulated lobulated heterogeneous soft tissue dense mass lesion taking significant enhancement on Intra Venous (IV) contrast injection, in naso-pharynx and left posterior choana of the nasal cavity, extending upto pterygopalatine and infratemporal fossa, masseter space of left side and involving the pterygoid muscles; ipsilateral sphenoid sinus and posterior ethmoid cells were also infiltrated. There was anterior bowing of posterior wall of ipsilateral maxillary sinus. The osteomeatal complex was invaded with erosion of the middle and inferior turbinate [Table/ Fig-2].Post-operative period was uneventful. The patient was discharged after three days. On follow up nasal endoscopy was done after 15 days and after three months. Nasal cavity was healthy and no signs of recurrence was seen. Surgical ProcedureThe surgery was done under general hypotensive anaesthesia with patient in supine reverse Trendelenberg [1] position and intraoral delivery of endotracheal tube. Keywords: Embolization, Midfacial degloving, Vascular tumours AbSTRACTJuvenile nasopharyngeal angiofibroma is tumour almost exclusively seen in adolescent males, constituting less than 1% of all neoplasms in head and neck. They are benign and locally spreading and are highly vascular in nature and thus prove to be a surgical challenge because of its complex anatomical location. Here, we present a case report of a 18-year-old male presenting with a mass in his left nasal cavity, with recurrent epistaxis ...

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