CPC on Nasopharyngeal Angiofibroma
Introduction
Nasopharyngeal Angiofibroma is a rare, benign but locally aggressive vascular tumor that predominantly affects adolescent males. Despite its benign histological nature, the tumor is clinically significant due to its aggressive growth pattern, high vascularity, tendency to cause recurrent epistaxis, and potential for extensive local invasion into adjacent structures. Delayed diagnosis or improper handling may result in life-threatening hemorrhage.
This presentation discusses the etiology, clinical presentation, diagnostic approach, radiological findings, staging, and management of nasopharyngeal angiofibroma, emphasizing the importance of early recognition and appropriate pre-operative planning to minimize complications.
Key Points
1. Epidemiology
Occurs almost exclusively in adolescent males, typically between 10–25 years.
Rare in females; presence should raise suspicion of hormonal or genetic abnormalities.
2. Etiology and Pathogenesis
Exact etiology remains unclear.
Strong association with androgen dependence, explaining male predominance.
Originates from the posterolateral wall of the nasopharynx, near the sphenopalatine foramen.
Characterized by rich vascular supply, mainly from branches of the external carotid artery.
3. Clinical Presentation
Recurrent, profuse epistaxis is the most common presenting symptom.
Progressive nasal obstruction (usually unilateral initially).
Facial swelling, headache, anosmia, and hearing loss may occur with tumor extension.
Advanced cases may present with proptosis or cranial nerve involvement.
4. Physical Examination
Reddish or bluish mass seen in the nasopharynx.
Tumor is friable and bleeds easily.
Biopsy is contraindicated due to risk of severe hemorrhage.
5. Radiological Evaluation
CT scan: Defines bony erosion and extent of the tumor.
MRI: Superior for soft tissue delineation and intracranial extension.
Angiography:
Identifies feeding vessels
Helps in pre-operative embolization planning
6. Staging
Multiple staging systems exist (e.g., Fisch classification).
Staging is based on:
Local extension
Involvement of paranasal sinuses
Intracranial spread
Accurate staging guides surgical approach and prognosis.
7. Management
Surgical excision is the treatment of choice.
Pre-operative embolization significantly reduces intra-operative blood loss.
Surgical approaches include:
Endoscopic
Transpalatal
Lateral rhinotomy (for extensive disease)
Radiotherapy reserved for unresectable or recurrent cases.
8. Complications
Severe intra-operative hemorrhage
Recurrence due to incomplete excision
Cranial nerve deficits in advanced disease
