A 25-year-old with recurrent profuse epistaxis has a CT scan showing a highly vascular lesion eroding the pterygoid plates arising from the posterior nasal cavity in a young male. Pre-operative embolization is planned. The most appropriate time interval between embolization and surgical excision (FESS/endoscopic) to reduce intraoperative blood loss while preventing revascularization is:

• A 24–48 hours ✓
• B Immediately (within 2 hours)
• C 7–10 days
• D 4–6 weeks

Explanation

In juvenile nasopharyngeal angiofibroma (JNA), pre-operative embolization (targeting the internal maxillary artery, ascending pharyngeal artery) reduces intraoperative blood loss by 50–75%. The optimal timing is 24–48 hours before surgery: embolization needs time to achieve maximal thrombosis and vascular stasis, but waiting longer (>72–96 hours) allows collateral neovascularization to develop, negating the benefit. Immediate surgery (<2 hours) may not allow adequate thrombus consolidation. This 24–48 hour window is the standard recommended interval. FESS/endoscopic resection has replaced the Caldwell-Luc and transpalatal approaches for most Radkowski stage I–IIC lesions.

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

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Written and medically reviewed by the StethoPrep medical team.