A 16-year-old male presents with progressive nasal obstruction, epistaxis, and a pulsatile nasopharyngeal mass. Biopsy is inadvertently performed and causes profuse uncontrollable bleeding. On contrast MRI, the mass shows intense enhancement and characteristic 'salt and pepper' appearance. The MOST appropriate preoperative intervention before surgical excision is:

• A Radiation therapy 45 Gy to reduce vascularity followed by surgical removal
• B High-dose prednisolone 1 mg/kg for 2 weeks to reduce tumour vascularity
• C Sclerotherapy with direct injection of ethanol into the tumour
• D Embolisation of feeding vessels (typically internal maxillary artery) 24–72 hours before surgery ✓

Explanation

Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular benign fibrovascular tumour occurring almost exclusively in adolescent males. Biopsy is absolutely contraindicated due to risk of massive haemorrhage. The standard pre-operative management is selective endovascular embolisation of the primary feeding vessel (usually the internal maxillary artery, a branch of the external carotid system) 24–72 hours before surgery to significantly reduce intraoperative blood loss. Post-embolisation necrosis and shrinkage also improve surgical planes. Primary radiotherapy is reserved for unresectable skull base involvement.

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.