A 16-year-old male presents with progressive unilateral nasal obstruction, intermittent epistaxis, and a biopsy-proven juvenile nasopharyngeal angiofibroma (JNA). Pre-operative angiography and embolization is performed. The primary feeding vessel in most JNA cases is:

• A Anterior ethmoidal artery
• B Internal carotid artery (cavernous portion)
• C Ascending pharyngeal artery
• D Internal maxillary artery (sphenopalatine branch of the maxillary artery) ✓

Explanation

Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular benign fibrovascular tumor arising from the posterolateral nasopharyngeal wall near the sphenopalatine foramen. Its primary blood supply is from the internal maxillary artery, specifically the sphenopalatine artery (terminal branch of the maxillary artery). Pre-operative embolization of this vessel 24–48 hours before surgical excision significantly reduces intraoperative blood loss. Advanced tumors may also recruit supply from the internal carotid artery, which cannot be embolized safely.

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

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Written and medically reviewed by the StethoPrep medical team.