A patient with recurrent unilateral nasal obstruction, blood-tinged mucus, and facial pain is found to have a vascular mass in the posterior nasopharynx on endoscopy. Angiography shows supply from the internal maxillary artery. The patient is a 16-year-old male. What is the MOST appropriate pre-operative management before definitive surgery?
- A Pre-operative embolization of feeding vessels 24–48 hours before surgery ✓
- B Intravenous corticosteroids for 5 days to reduce vascularity
- C Radiation therapy to reduce tumor size before surgery
- D Propranolol to reduce blood flow to the lesion
Correct answer: A. Pre-operative embolization of feeding vessels 24–48 hours before surgery
Explanation
The presentation describes juvenile nasopharyngeal angiofibroma (JNA) — a benign but highly vascular tumor exclusively in adolescent males, with blood supply primarily from the internal maxillary artery (ascending pharyngeal and sphenopalatine branches). Pre-operative embolization of feeding vessels 24–48 hours before surgery significantly reduces intraoperative blood loss (the main hazard of JNA surgery). Embolization is now standard of care before any surgical approach to JNA. Steroids and propranolol are not established treatments for JNA.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.