What’s the diagnosis?
- Juvenile angiofibroma is a tumor seen almost exclusively in teenage boys between 10 and 20 years old. Classic presentation symptoms include recurrent, unprovoked epistaxis and nasal obstruction.
- Technically, this tumor is “benign,” but its anatomic location in the posterior nasal cavity and its expansive and destructive growth pattern → morbidity.
- It is typically diagnosed based on imaging alone. The tumor is very bloody and incisional biopsies, such as those routinely performed in the otolaryngology clinic for other nasal pathology, are not performed because of the risk of massive hemorrhage.
What's your treatment plan?
In this case, preoperative embolization of this sinonasal tumor was performed. The right external carotid artery was catheterized and the right internal maxillary artery feeders were embolized with Onyx. The patient was subsequently taken to the operating room for resection of the mass.
It is important to image the contralateral external carotid artery again, after the embolization has been completed, to determine whether or not the tumor has recruited significant supply from a new feeder, since it has lost its right-sided feeder. In this case, the tumor did not recruit significant left external carotid artery contribution.