A 16-year-old male presents with progressive nasal obstruction, unilateral epistaxis, conductive hearing loss, and a smooth, pulsatile nasopharyngeal mass. CT shows a hypervascular mass in the nasopharynx extending into the pterygopalatine fossa with anterior bowing of the posterior maxillary sinus wall (Holman-Miller sign). The diagnosis is juvenile nasopharyngeal angiofibroma (JNA). Which is the MOST COMMON arterial supply to this tumor?

• A Ascending pharyngeal artery (branch of external carotid artery) alone
• B Internal carotid artery via the cavernous sinus branches
• C Vertebral artery via posterior communicating branches
• D Internal maxillary artery (branch of external carotid artery), specifically the pterygopalatine segment — this is the primary feeding vessel in 85-90% of cases ✓

Explanation

JNA is a highly vascular benign tumor of adolescent males, arising from the posterolateral nasal wall/sphenopalatine foramen. The primary blood supply in 85-90% of cases is the internal maxillary artery (pterygopalatine segment of ECA), with additional supply from the ascending pharyngeal artery, and in larger tumors extending intracranially, from the internal carotid artery. Preoperative angiography and embolization (24-48 hours before surgery) of feeding vessels reduces intraoperative blood loss. Holman-Miller sign (anterior bowing of posterior maxillary antral wall) is the pathognomonic CT finding.

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

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Written and medically reviewed by the StethoPrep medical team.