Juvenile nasopharyngeal angiofibroma - Surgery without pre-operative embolization?

Abstract

Juvenile nasopharyngeal angiofibroma is a tumour-like vascular malformation of the nasopharynx, arising from the sphenopalatine foramen. CT, MRI and angiography are important diagnostic tools, the latter also being advocated for pre-operative embolization of the lesion in order to reduce intra-operative bleeding. Embolization, however, presents its own risks and thus, should only be performed in highly experienced centers. A case-report of a sixteen year old male with a Fish type 2 angiofibroma with important pterygopalatine fossa invasion is presented.

Tumour resection was preceded by the endonasal trans-antral ligation of the internal maxillary artery, with immediate impact on intra-operative bleeding. At the same time, the endoscopic pterygopalatine fossa dissection itself, was essential in the management of the tumour invasion at this particular site. The authors illustrate how surgery can safely be done in small to medium sized tumours by the endonasal endoscopic trans-antral ligation of the internal maxillary artery in the pterygopalatine fossa, being an effective alternative to preoperative embolization, and its inherent risks.