EN4.31 | Nasopharyngeal Angiofibroma — Summary & Reflection

KEY TAKEAWAYS

Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressive fibrovascular tumour arising from the posterolateral nasal wall near the sphenopalatine foramen, occurring almost exclusively in adolescent males (peak age 14–17 years). The classic triad is progressive unilateral nasal obstruction, recurrent severe spontaneous epistaxis, and a visible nasopharyngeal mass. The histological substrate (thin-walled vascular channels without muscular media) explains why JNA bleeds catastrophically when biopsied — biopsy is absolutely contraindicated. Diagnosis is made on contrast CT (brightly enhancing mass, Holman-Miller sign — anterior bowing of the posterior maxillary wall) and MRI (skull base extent, intracranial extension). Tumour is staged by extent (Stage I = nasal cavity/nasopharynx to Stage IV = intracranial). Management: pre-operative selective angiographic embolisation of the internal maxillary artery 24–48 hours before surgical excision; endoscopic excision for Stage I–II; open approaches for advanced disease; radiotherapy reserved for unresectable intracranial extension. Recurrence rate ~20%; post-operative MRI surveillance mandatory. Histological confirmation from the resection specimen, not biopsy.

REFLECT

You are the ENT registrar on call. A general surgical colleague calls you saying he has a 16-year-old male with a nasal mass who is bleeding, and asks whether he should 'take a quick biopsy to find out what it is.' How do you respond? Reflect on the communication challenge: you need to convey urgency and an absolute prohibition clearly and without causing alarm, to a colleague who may not be familiar with ENT tumours. What information would you communicate, and how would you arrange the correct next steps — imaging, ENT review, and embolisation planning — without delay?