A 16-year-old male presents with progressive unilateral nasal obstruction, recurrent epistaxis, and a mass in the nasopharynx that is highly vascular on endoscopy. CT shows a mass centered at the sphenopalatine foramen extending into the pterygopalatine fossa with bone erosion. Which of the following angiographic and surgical statements about this tumor is CORRECT?

• A Its blood supply is exclusively from the internal carotid artery, making preoperative embolization impossible
• B Surgical resection is contraindicated due to risk of intracranial extension; irradiation is primary treatment
• C Preoperative embolization of the internal maxillary artery (sphenopalatine artery) is the principal feeding vessel and is performed 24–48 hours before surgical resection to reduce intraoperative blood loss ✓
• D FNA biopsy of the nasopharyngeal mass is the recommended first diagnostic step to confirm diagnosis before any intervention

Explanation

Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular benign tumor of adolescent males arising at the sphenopalatine foramen. Its primary blood supply is from the internal maxillary artery (sphenopalatine branch), with secondary supply from the ascending pharyngeal artery, vidian artery, and occasionally the internal carotid artery in advanced cases. Preoperative angiographic embolization of the feeding vessels (especially internal maxillary artery) 24–48 hours before surgery significantly reduces intraoperative hemorrhage and facilitates complete resection. FNA is contraindicated due to severe hemorrhage risk. Surgery (endoscopic or open approach) is the primary treatment; radiation is reserved for unresectable intracranial disease.

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

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Written and medically reviewed by the StethoPrep medical team.