Juvenile Nasopharyngeal Angiofibroma from ENT Text

1. Dr. Gladson M. Robin

2. • Rare Benign tumor of Nasopharynx
• Commonest of all benign tumors of the Nasopharynx

4. Posterior part of Nasal Cavity close to the
Superior margin of Sphenopalatine foramen

5. • Angio (Vasular) + Fibroma (Fibrous)
• Ratio of the two components vary
• Most vessels are just endothelium-
lined spaces with no elastic or
muscular coat  SEVERE BLEEDING

7. 5. Cranial cavity:
a) ACF through roof of Ethmoids or Cribriform plate
b) MCF through:
a) Direct invasion through erosion of floor
b) Indirect invasion through Sphenoid sinus
(lateral to ICA) or Sella Tursica (medial to ICA)

9. • Obstruction of ET  Conductive hearing loss and Otitis media with
effusion
• Mass in the Nasopharynx:
• Tumour is sessile, lobulated or smooth
• Pink or purplish in colour
• Consistency is firm but digital palpation should never be done until at the
time of operation

10. Other clinical features:
• Broadening of nasal bridge
• Proptosis
• Swelling of cheek
• Involvement of IInd, IIIrd, IVth and VIth cranial nerves

11. • Mostly based on clinical picture
• Biopsy of the tumour is attended with profuse
bleeding and is, therefore, avoided.
• If essential – biopsy done under GA with
arrangements to control bleeding.

12. Investigation of choice:
• CT scan of head
• Shows the extent of tumour, bony
destruction or displacements.
• Anterior bowing of the posterior wall of
maxillary sinus, often called antral sign
or Holman-Miller sign, is pathognomic
of angiofibroma.

15. Radiotherapy:
Used for intracranial extension of disease when tumor derives its blood
supply from the internal carotid system.
Recurrent angiofibromas
Radiation to nasopharynx in the young has the risk of development of
malignancy at a later age

17. Very aggressive recurrent tumours and residual lesions have been
treated by chemotherapy.
Doxorubicin, vincristine and dacarbazine have been used in
combination.
Chemotherapy and radiotherapy can arrest the growth and cause some
tumour regression but not total tumour eradication

18. 1. Observation: The tumor may spontaneously regress.
2. Revision surgery and removal. If it recurs even after revision
surgery, radiotherapy may be considered.
3. Radiation reduces the blood supply and the tumor subsides over
time. It is also used when tumor recurrence is surgically
inaccessible.
Recurrence of juvenile angiofibroma is not
uncommon and has been reported in up to 35%.

19. Thank you…. 