Angiofibroma Of The Nose

JUVENILE NASOPHARYNGEAL ANGIOFIBROMA (JNA)

Juvenile Nasopharyngeal Angiofibroma (JNA) is a noncancerous yet highly aggressive and invasive vascular (made of blood vessels)  tumour found in the back of the nasal cavity, usually in young adolescent males in the age range of 15-19 years.

The reason that these tumours are potentially life threatening is because they bleed easily on touch. This bleeding is often mistaken for non-significant causes of nasal bleed in youngsters like local nasal trauma and thus the JNA is neglected till the pathology grows in size significantly causing facial skeletal changes or nasal obstruction.

These tumours grow in the vascular regions of the back the nasal cavity deriving blood feeders from the main blood vessels of nasal cavity, the back of throat and or the direct supply from the main vessels of head neck, the carotids.

Why is Juvenile Nasopharyngeal Angiofibroma notorious  ?

  • There is no definitive cause attributed to formation of the tumour.
  • It is highly vascular and invasive.
  • There are high chances of recurrence.
  • It has the Potential to spread: into the front of the nasal cavity when it becomes visible and blocks the nose; into the back of the cheek bone or into the cheek bone causing facial swelling; into the skull base and eye socket through the sinuses or the openings in the skull base or into the brain after destruction of the skull base.

What are the possible Symptoms of Juvenile Nasopharyngeal Angiofibroma ?

  • Nasal bleeding (Minor bleeds on and off, or torrential bleeding episode)
  • Nasal blockage : unilateral (one side) or bilateral (both sides).
  • Facial swelling
  • Altered mobility of eyes ( if the mass has spread into the eye socket )

How do we diagnose a Juvenile Nasopharyngeal Angiofibroma ?

Our ENT specialist will discuss your symptoms , carry out a thorough examination and this includes an endoscopic examination of the nose in a controlled setting . A high degree of clinical suspicion ensures that the one does not take a biopsy of the visible mass.

The common investigation we ask for are imaging studies : i. A Contrast Enhanced CT scan of  the Para Nasal Sinuses to assess the extent of disease and surgical planning. ii. Contrast enhanced MRI of the sinuses and head in situations of intra orbital and intracranial extension.

What is the treatment for Juvenile Nasopharyngeal Angiofibroma  ?

Surgical removal is the treatment of choice for JNA. There are different surgical approaches for its removal . Read here for more details on the surgery for JNA.

What is Pre-Operative angiography & embolization ?

Depending on the size and extent of the tumour, we may consider Pre-Operative angiography & embolization 24 to 48 hours prior to the surgery. This procedure is done by our intervention radiologist colleague. Angiography shows up the blood supply to the tumour and thus aids in surgical planning by knowing the feeder vessels ; Embolization plugs the feeding blood vessels and thus decreases  tumour volume by reducing the  blood flow through the tumour. This in turn subsequently decreases intraoperative blood loss and morbidity and mortality of the surgery.

Our experienced team of ENT – Head and Neck Surgeon at Adventis ENT will be happy to discuss any concerns you may have with nasal bleeding or nasal blockage and the management of Juvenile Nasopharyngeal Angiofibroma.

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