Nasal angiofibroma is seen in which age-
Adolosent male
Adult male
Elderly male
Elderly female
Ans. is 'a' i.e., Adolosent male o Nasopharyngeal fibroma occurs exclusively in male, in age 7-19 years.o Nasal polyp is also a differential diagnosis here. But it can be ruled out as there is bilateral nasal obstruction. In young patient, nasal polyp is antrochoanal polyp which usually causes unilateral nasal obstruction. Bilateral nasal obstruction is seen in ethmoidal polyp, which occur mostly in adult age.o So, the diagnosis is juvenile nasopharyngeal angiofibroma.Juvenile nasopharyngeal angiofibromao Juvenile nasopharyngeal angiofibroma (JNA) is a benign, but locally aggresive, tumor of nasopharynx seen in prepubertal and adolescent males.o It is the most common benign neoplasm of nasopharynx.o It is a highly vascular tumor and blood supply of the tumor most commonly arises from the internal maxillary artery.o Juvenile nasopharyngeal angiofibroma (JNA) occurs almost exclusively in males.o Female with Juvenile nasopharyngeal angiofibroma (JNA) should undergo genetic testing.o Onset is most commonly in the second decades, the range is 7-19 years.o The exact cause is unknown. As the tumour is predominantly seen in adolescent males in the second decade of life, it is thought to be testosterone dependent.o The most common site is posterior part of nasal cavity close to the margin of sphenopalatine foramen.o The tumor starts adjacent to the sphenopalatine foramen.o Large tumors are frequently bilobed or dumbbel shaped, with one portion of tumor filling the nasopharynx and the other portion extending to the pterygopalatine fossa.Clinical featureso Symptoms depend on spread of tumour to nasal cavity, paranasal sinuses, pterygomaxillary fossa, infratemporal fossa, cheek, orbits (through inferior orbital fissure), cranial cavity (most common site is middle cranial fossa).o Nasal obstruction (80-90%) is the most common symptom, especially in the initial stages. This results in denasal speech, hyposmia, broadening of nasal bridge.o Spontaneous profuse & recurrent epistaxis is the second most common symptom o Otalgia, conductive hearing loss, serous otitis media, due to eustachian tube obstruction.o Pink or purplish mass obstructing one or both chonae in nasopharynx.o Tumour in the orbit causes : proptosis; and frog-face deformity; diplopia and diminshed vision.o Tumour in infratemporal fossa can cause trismus and bulge of parotid.o II, III, IV, V, VI cranial nerve can be involved.o Splaying of nasal bones.o Swelling of cheek and fullness of face.Diagnosis and treatment o Contrast CT is the investigation of choice.o Biopsy should be avoided as it can cause severe bleeding.o Surgical excision is the treatment of choice.
Benign Tumors