Nasopharyngeal angiofibroma

• Definition:
• Nasopharyngeal angiofibroma is a
histologically benign but locally aggressive
vascular tumor of the nasopharynx that is
made up of blood vessels and fibrous
(connective) tissue. it arises from the superior
margin of the sphenopalatine foramen and
grows in the back of the nasal cavity.
• It most commonly affects adolescent males
(because it is a hormone-sensitive tumor).
• it is a benign tumor, it is locally invasive and
can invade the nose, cheek, orbit (frog face
deformity), or brain.
•  Patients with nasopharyngeal angiofibroma
usually present with one-sided nasal
obstruction with profuse epistaxis.
 Signs and symptoms
• Frequent chronic epistaxis or blood-tinged nasal
discharge.
• Nasal obstruction and rhinorrhea.
• Facial dysmorphism (when locally invasive)
• Conductive hearing loss from eustachian-tube
obstruction
• diplopia, which occurs secondary to erosion into superior
orbital fissure and due to third and sixth nerve palsy.
• Proptosis when having intraorbital extension.
• Rarely anosmia, recurrent otitis media, and eye pain.
 Diagnosis
• If nasopharyngeal angiofibroma is suspected
based on physical examination (a smooth
vascular submucosal mass in the posterior
nasal cavity of an adolescent male), imaging
studies such as CT or MRI should be
performed.
• Biopsy should be avoided as to avoid extensive
bleeding since the tumor is composed of blood
vessels without a muscular coat.
• Antral sign or Holman-Miller sign, it refers to
the anterior bowing of the posterior wall of
the maxillary antrum as seen on a lateral skull
radiograph or cross sectional imaging.
• DSA (digital subtraction angiography) of
carotid artery to see the extension of tumors
and feeding vessels.
Radkowski staging of angiofibroma
 Treatment
• The primary treatment for nasopharyngeal angiofibroma
is surgery to remove the tumor. Depending on the size
and location of the tumor, doctors may be able to
remove it through the nose by endoscopic surgery.
• In some cases, doctors cannot remove part of the tumor
because of its location. If it isn’t possible to remove the
whole tumor, or if it regrows after surgery, radiation
treatments are reccomended. Radiation therapy targets
the tumor with high-energy beams that cause it to
shrink.
 Prognosis
• Prognosis for nasopharyngeal angiofibroma is
favorable. Because these tumors are benign,
metastasis to distal sites does not occur.
However, these tumors are highly vascularized
and grow rapidly. Removal is important in
preventing nasal obstruction and recurrent
epistaxis.