The tumour starts adjacent to the sphenopalatine foramen. They initially fill the nasal cavity and nasopharynx. The tumour can extend superiorly towards the sphenoid sinus. The cavernous sinus may become invaded if the tumour advances further. Laterally, the tumour extends through the pterygopalatine fossa, bowing the posterior wall of the maxillary sinus, into the infratemporal fossa. Extending through the orbital fissures can cause proptosis and optic nerve atrophy.
CT as well as MRI is done to know the extent of this highly vascular tumour. Biopsy should be avoided as to avoid extensive bleeding since the tumour is composed of blood vessels without a muscular coat. To reduce the blood loss during surgery, angiography is done to block the artery that supplies blood to the tumour and is known as embolization (Fig. 1 & 2).
Treatment for Nasopharyngeal angiofibroma (JNA) is primarily surgical. In the past, tumour was exposed through the mouth or by making incisions in the face (transpalatal, lateral rhinotomy, transmaxillary, maxillary swing and mid-face degloving approaches). Currently, advanced endoscopic sinus & skull base surgery techniques have been used successfully to remove these tumours. Considerable surgical experience is required to successfully perform the endoscopic operation.
