A 12-year-old boy presents with progressive unilateral nasal obstruction and episodic profuse nasal bleeding. Examination reveals a fleshy, pinkish-grey mass in the nasopharynx. CT shows extension into the pterygopalatine fossa with bone erosion. The most likely diagnosis and its primary blood supply respectively are:

• A Juvenile nasopharyngeal angiofibroma; sphenopalatine artery ✓
• B Inverted papilloma; anterior ethmoidal artery
• C Chordoma; internal carotid artery
• D Rhabdomyosarcoma; facial artery

Explanation

Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressive vascular tumour that arises from the posterolateral nasal wall near the sphenopalatine foramen, predominantly in adolescent males. It is the most common benign nasopharyngeal tumour in this age group. Its primary blood supply is the internal maxillary artery (sphenopalatine branch), and preoperative embolisation followed by surgical excision is the standard treatment.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.