A 14-year-old boy presents with unilateral nasal obstruction, recurrent massive epistaxis, and cheek fullness. CT scan shows a hypervascular mass centred on the sphenopalatine foramen with extension into the pterygopalatine fossa. The MOST appropriate management sequence is:

• A Immediate surgical resection to prevent further blood loss
• B Radiation therapy as primary definitive treatment
• C Testosterone receptor antagonist therapy for 6 months followed by reassessment
• D Preoperative superselective angiographic embolization 24-72 hours before surgical resection ✓

Explanation

Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressive, hormonally sensitive (androgen-driven), highly vascular tumour in adolescent males. The primary blood supply is from the internal maxillary artery (branch of ECA), with contributions from the vidian artery and ascending pharyngeal artery. Current standard of care is preoperative superselective angiographic embolization of feeding vessels 24-72 hours before surgery, reducing intraoperative blood loss by 60-70% and facilitating complete resection. Radiation therapy is reserved for unresectable intracranial extension or recurrent disease. Testosterone antagonists have no established primary treatment role.

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

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Written and medically reviewed by the StethoPrep medical team.